Clinical Performance Improvement Research Articles

Effects of virtual reality training on clinical skill performance in nursing students: A systematic review, meta-analysis and meta-regression.

This review examined the impact of virtual reality (VR) training on nursing students' clinical skill performance and identified essential features of VR training. VR provides immersive content, simulating real-life scenarios and preventing errors in clinical settings. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies were obtained from Ovid-EMBASE, MEDLINE, CINAHL and PubMed. Studies related to VR training published from 1 January 2000 to 8 May 2024 were included. Comprehensive Meta-Analysis 4.0 software was used for meta-analysis and random effects meta-regression. The overall effect was assessed with Hedges' g and Z-statistics (p < 0.05). Heterogeneity was measured using I-squared (I2) statistics. Among the 31 476 studies, 11 randomized controlled trial studies were included. Meta-analysis demonstrated a significant improvement in clinical skill performance, with a medium to large effect (g = 0.61) in the VR group (Z = 3.80, p < 0.001). Subgroup analyses highlighted higher nursing skills in the VR training topic. Meta-regression revealed that the VR training topic (β = 1.23, p < 0.001) and method of VR training (β = -0.53, p = 0.05) were significant covariates influencing clinical skill performance. VR training improves nursing students' clinical skill performance, addressing shortcomings in the clinical practicum.

Evaluation of adhesive properties and enzymatic activity at the hybrid layer of a simplified adhesive loaded with 0.2% Cu and 5% ZnO nanoparticles: a Randomized Clinical Trial and ex vivo analysis.

ObjectiveThe aim of this study was to evaluate the effect of an adhesive loaded with 0.2% cooper (Cu) and 5% zinc oxide (ZnO) nanoparticles (Nps) on its adhesive properties and enzymatic activity at the hybrid layer ex vivo in a randomized clinical model. MethodsFifteen patients participated in this study, and a total of 30 third molars were used. Occlusal cavities (4 × 4 × 2 mm) were made in each tooth, and randomly divided into 2 groups: (i) Experimental group: commercial adhesive loaded with 0.2wt% CuNps and 5wt% ZnONps; and (ii) Control Group: non-loaded commercial adhesive. Teeth were restored with resin composite. Thirty days later, extractions were performed. Extracted teeth were longitudinally sectioned. Nps in powder were characterized by field emission scanning electron microscope (FE-SEM) and energy dispersive X-ray (EDX) analysis. Microtensile bond strength (μTBS), degree of conversion (DC), and nanoleakeage (NL) tests were executed. In situ zymography (Zym) was performed to evaluate the gelatinolytic activity at the hybrid layer. Student's t-test (α = 0.05) was applied for all tests. ResultsμTBS and DC did not show significant differences (p > 0.05) between both groups. However, NL and gelatinolytic activity at the hybrid layer showed significant values (p < 0.05) for experimental group in comparison with control group. ConclusionThe addition of 0.2% CuNps and 5% ZnONps to a universal adhesive decreases NL and gelatinolytic activity at the hybrid layer, without jeopardizing its adhesive properties. SignificanceThis randomized clinical trial with ex vivo analysis demonstrate that a commercial adhesive modified with 0.2wt% Cu and 5wt% ZnO Nps that does not affect its adhesive properties, reducing gelatinolytic activity and nanoleakage at the hybrid layer, which should contribute to an improvement of long term bonding-dentine clinical performance.

Impact of a shorter university week on academic performance and study–life balance of dental students

ABSTRACT Background: The 4-day workweek is gaining traction as a credible and effective alternative to conventional 5-day workweek. We aimed to investigate the impact of a 4-day workweek on dental students’ academic performance and study–life balance. Methods: A total of 284 dental students participated in answering an electronic questionnaire. The response scores, mean values, and standard deviations were calculated. Internal consistency and associations between the scores were tested. Differences in responses between preclinical and clinical year students were evaluated. SPSS was used for data analysis, with a significance set at P &lt; 0.05. Results: A total of 246 students reported satisfactory experiences with the new 4-day university week. The majority preferred to continue with the short-week scheme. There were no statistically significant differences between preclinical- and clinical-level scores. A total of 73.3% of the students reported an increase in patient treatment and clinical procedures compared to the previous year with a 5-day schedule. Most students were satisfied with their weekly workload. They reported a significant improvement in clinical performance with the new weekly plan. Introducing a 4-day university week helped 76% of students reduce the cost of attending college. Conclusion: The introduction of the 4-day study week at the College of Dental Medicine was welcomed by students across all years of the program due to the improved academic achievement and clinical training opportunities it provided. They were also satisfied with the longer weekend, as it helped them relieve stress, prepare better for examinations, and spend more time with their family and friends.

Comparison of Circulating Tumor DNA Assays for Molecular Residual Disease Detection in Early-Stage Triple-Negative Breast Cancer.

Detection of circulating tumor DNA (ctDNA) in patients who have completed treatment for early-stage breast cancer is associated with a high risk of relapse, yet the optimal assay for ctDNA detection is unknown. The cTRAK-TN clinical trial prospectively used tumor-informed digital PCR (dPCR) assays for ctDNA molecular residual disease (MRD) detection in early-stage triple-negative breast cancer. We compared tumor-informed dPCR assays with tumor-informed personalized multimutation sequencing assays in 141 patients from cTRAK-TN. MRD was first detected by personalized sequencing in 47.9% of patients, 0% first detected by dPCR, and 52.1% with both assays simultaneously (P < 0.001; Fisher exact test). The median lead time from ctDNA detection to relapse was 6.1 months with personalized sequencing and 3.9 months with dPCR (P = 0.004, mixed-effects Cox model). Detection of MRD at the first time point was associated with a shorter time to relapse compared with detection at subsequent time points (median lead time 4.2 vs. 7.1 months; P = 0.02). Personalized multimutation sequencing assays have potential clinically important improvements in clinical outcome in the early detection of MRD.

The Effects of Blended Learning Using Virtual Reality Simulation in Pediatrics-adolescent Nursing Clinical Practice

This study was to compare the effects of blended learning that integrates child-adolescent nursing clinical practice and virtual reality simulation. The aim of this study was to evaluate the effectiveness of blended learning in parallel clinical practice of child-adolescent nursing and virtual reality simulation of child-adolescent nursing by comparison of critical thinking, problem-solving processes, and clinical performance in both education groups before and after the educational intervention. The participants were 48 nursing college students. The experimental group (n=22) exposed a blended learning using virtual reality simulation, combining child-adolescent nursing clinical practice education, while the control group (n=26) received only child-adolescent nursing clinical practice curriculum course. The data collection period was from March 8 to November 26, 2021. The general characteristics of subject’s were analyzed by number, percentage, mean and standard deviation. And clinical practice fused with virtual reality simulation, that is, homogeneity verification of the blended learning education group was analyzed by x2 test and independent t-test. Whether there is a differences between pretest and posttest critical thinking tendency, problem-solving process, and clinical performance ability of the blended learning and the clinical practice education group was analyzed by independent t-test. The pretest &amp; posttest results of each group showed statistically significant improvements in critical thinking, problem-solving processes, and clinical performance. In a comparison of the results of the two groups, the only statistically significant difference was found for critical thinking. Furthermore blended learning, combining a v-sim and a clinical nursing practice, into the nursing curriculum may contribute to the further development of nursing education.

Short term effect of sodium glucose cotransporter 2 inhibitors and sacubitril/valsartan on comprehensive geriatric assessment and oxidative stress in elderly with chronic heart failure (from MAGIC-HF)

Abstract Background Sodium Glucose Cotransporter 2 inhibitors (SGLT2i) and Sacubitril/Valsartan (Sac/Val) have improved clinical prognosis in patients affected by heart failure (HF) with reduced ejection fraction (HFrEF). Cognitive impairment, depression, and poor physical functional performance are a very common comorbidity in patients with HF and result in a worse prognosis. Purpose The aim of this study was to evaluate the potential effects of SGLT2i on functional, humoral, and cognitive aspects, assessed by performing a comprehensive geriatric assessment (CGA), and on oxidative stress and platelets activation biomarkers, in a cohort of HFrEF elderly, and any differences between men and women. Methods We enrolled 91 HFrEF patients (63 men and 28 women, mean age 73.7±4.7 years) in the "MAgna GraecIa evaluation of Comorbidities in patients with Heart Failure STUDY (MAGIC-HF STUDY). Men and women differed for use of glucagon-like-peptide 1 receptor agonists, antiplatelet drugs, and circulating levels of NADPH Oxidase 2 (Nox-2). SGLT2i therapy was introduced in patients already treated with Sac/Val for at least 12 months who were taking an average dose of 273.6±102.0 mg/die. Results After 3 months follow-up, we observed a significant improvement in cognitive, humoral and functional parameters of CGA, NTpro-BNP levels and echocardiographic parameters. Changes (Δ) in Montreal Cognitive Assessment (MoCA) (p=0.015) and Cardiac Index (CI) which were greater in men (p&amp;lt;0.0001) and Geriatric Depression Scale (GDS) which were greater in women (p=0.029). In the whole population, multivariate analysis shows that Δ of CI, Homeostatic model assessment (HOMA), Sp-Selectina, Nox-2 and 8-Isoprostane contributed for 19.7% (p&amp;lt;0.0001), 9.4% (p=0.001), 6.4% (p=0.002), 3.8% (p=0.013) and 2.9% (p=0.024) to Mini mental state examination (MMSE) variability, respectively, and the whole model accounted for a 42.2% of MMSE variation; moreover Δ of HOMA, Sp-Selectina and highly sensitive c-reactive protein (hs-CRP) contributed for 21.6% (p&amp;lt;0.0001), 5.7% (p=0.002) and 4.0% (p=0.014) to MoCA variability, respectively, and the whole model accounted for a 33.3% of MoCA variation. In addition, Δ of Sp-Selectina, Nox-2, CI and HOMA globally contributed for 37.5% of GDS variation (p&amp;lt;0.05); and Δ of HOMA and Sp-Selectina contributed for 30.9% of Short performance physical battery variation (p&amp;lt;0.0001). Conclusions This represents the first real-world study carried out in an elderly population suffering from chronic HFrEF with several comorbidities, in which the addition of SGLT2i, in patients already treated with the best medical therapy including Sac/Val, after three months induced important improvements in clinical, humoral, hemodynamic, functional outcomes and cognitive performance. This study shows that echocardiographic and cognitive improvements are greater in men than in women, instead metabolic and humoral improvements are greater in women.

Temperature-responsive PCL-PLLA nanofibrous tissue engineering scaffolds with memorized porous microstructure recovery.

Biomaterial scaffolds in tissue engineering facilitate tissue regeneration and integration with the host. Poor healing outcomes arise from lack of cell and tissue infiltration, and ill-fitting interfaces between matrices or grafts, resulting in fibrous tissue formation, inflammation, and resorption. Existing tissue engineering scaffolds struggle to recover from deformation to fit irregularly shaped defects encountered in clinical settings without compromising their mechanical properties and favorable internal architecture. This study introduces a synthetic biomaterial scaffold composed of high molecular weight poly (L-lactic acid) (PLLA) and an interpenetrating network of poly (ε-caprolactone) (PCL), in a composition aiming to address the need for conformal fitting synthetic matrices which retain and recover their advantageous morphologies. The scaffold, known as thermosensitive memorized microstructure (TS-MMS), forms nanofibrous materials with memorized microstructures capable of recovery after deformation, including macropores and nanofibers. TS-MMS nanofibers, with 50-500 nm diameters, are formed via thermally induced phase separation (TIPS) of PLLA after in situ polymerization of PCL-diacrylate. A critical partial-melting temperature of TS-MMS at 52°C enables bulk deformation above this temperature, while retaining the nanofibrous and macroporous structures upon cooling to 37°C. Incorporation of drug-loaded poly (lactide-co-glycolide) (PLGA) nanoparticles directly into TS-MMS nanofibers during fabrication allows sustained release of a model drug for up to 40 days. Subcutaneous implantation in vivo using LysM-Cre;td-Tomato; Col1eGFP mice demonstrates successful cellularization and integration of deformed/recovered TS-MMS materials, surpassing the limitations of deformed PLLA scaffolds, to facilitate cell and vasculature infiltration requisite for successful bone regeneration. Additionally we demonstrated a method for embedding controlled release vehicles directly into the scaffold nanofibers; controlled release of simvastatin enhances vascularization and tissue maturation. TS-MMS scaffolds offer promising improvements in clinical handling and performance compared to existing biomaterial scaffolds.

The effectiveness of quality management strategies in health care organizations: an analysis of quality standards implementation and clinical performance improvement

Quality management strategies in healthcare institutions require an increasingly refined quality management system. This study aims to analyze the ISO 9001:2015 Standard for the implementation of a quality management system in the field of medical services provided by healthcare facilities, as well as to determine patterns during performance to assess the effectiveness of the quality management strategy. The article discusses key factors for achieving the quality management strategy through the implementation of a quality management system to improve clinical indicators. This system, according to the requirements of the ISO 9001:2015 Standard, ensures quality service provision. A cyclical sequence of actions is used to analyze quality management system implementation. It is applied to quality service processes in healthcare organizations and reflects some key aspects (planning, execution, activities, and verification of all relevant processes as described in the ISO 9001:2015 Standard). The authors have examined the quality management strategy based on the literature review and the analyzed standard. This strategy includes leadership, adapting quality improvement initiatives, setting the boundaries of managerial and clinical policies. All the above allow the integration of quality improvement initiatives into a sustainable, organized system with continuous enhancement.

A Novel Elastic Sensor Sheet for Pressure Injury Monitoring: Design, Integration, and Performance Analysis

This study presents the SENSOMATT sensor sheet, a novel, non-invasive pressure monitoring technology intended for placement beneath a mattress. The development and design process of the sheet, which includes a novel sensor arrangement, material selection, and incorporation of an elastic rubber sheet, is investigated in depth. Highlighted features include the ability to adjust to varied mattress sizes and the incorporation of AI technology for pressure mapping. A comparison with conventional piezoelectric contact sensor sheets demonstrates the better accuracy of the SENSOMATT sensor for monitoring pressures beneath a mattress. The report highlights the sensor network’s cost-effectiveness, durability, and enhanced data measurement, alongside the problems experienced in its design. Evaluations of performance under diverse settings contribute to a full understanding of its potential pressure injury prediction and patient care applications. Proposed future paths for the SENSOMATT sensor sheet include clinical validation, more cost and performance improvement, wireless connection possibilities, and improved long-term monitoring data analysis. The study concludes that the SENSOMATT sensor sheet has the potential to transform pressure injury prevention techniques in healthcare.

Qualitative content analysis of the highly cited articles in medical education: Trends and characteristics associated with citation of published studies in medical education research

Purpose To explore and describe the highly cited articles’ themes of research in medical education and to provide an insight into and reflection on which the elites of medical education society invested their energies from 2009 to 2018. Methods An in-depth content analysis as a research technique for the objective, systematic, and quantitative description of the manifest content of communication was used to quantitatively assess subject interests, methods, and other characteristics associated with citation of published studies in medical education research. Meaning units were compacted and coded with labels and categories in two phases. Results Among a variety of topics, methods, and strategies, 764 codes, 24 descriptive themes, and seven categories were extracted from the content analysis as the most prominent. Categories of medical education research were: modern technologies updating in medical education; learner performance improvement; sociological aspects of medical education; clinical reasoning; research methodology concerns of medical education; instructional design educational models; and professional aspects of medical education. Conclusions Commitment to continuous revision of educational emphasis and concerns on technological, sociological, and methodological concerns were the most repeated components of the highly cited articles that were ascertained through increased structure course designs and instructional strategies of the flipped classrooms to realize clinical reasoning and performance improvement. Practice points It becomes increasingly urgent to understand how various educational processes and technology-enhanced innovations affect each other and do or could influence learning outcomes, clinical reasoning, and performance improvement. Modern technologies as techniques to administer the changing educational and social environment, can supply and support the infrastructure and basis for operating many of the challenges in preparing the medical education community for the future. Research in the medical education context in the future should be focused on the inter-relationships of prominent and marginalized educational themes and categories.

Perceived Usefulness of Smartphone Medical Apps As Theoretical and Clinical Learning Aids Among Medical Students in Pakistan: A Cross-Sectional Study.

Background Smartphone applications have become popular tools in clinical educational environments, particularly because they enhance learning in any setting through their accessibility.Despite students utilizing these apps in their daily learning, Pakistan's medical education system has yet to strongly endorse them. Given the rising usage of medical applications among clinical year medical students and the wide range of apps accessible on contemporary devices aimed specifically at the student population, there is a lack of literature addressing the use of these apps on clinical learning in low- and middle-income countries (LMIC) such as Pakistan. Objectives Our study aims to (1) assess the level of awareness among clinical-year medical students in Pakistan, of smartphone applications for academic purposes, (2) determine the usefulness of medical apps as educational tools for clinical-year medical students, in terms of enhancing overall patient-care skills and (3) identify barriers to the usage of apps amongstudents who do not have them installed. Methods This online questionnaire-based study includes clinical year medical students across four medical colleges (two private and two public sectors) in Pakistan. Participant identity was kept anonymous and informed consent was required to participate. A sample size of 360 was used based on previous studies in the UK and student estimates from chosen medical colleges. The questionnaire tool used consists of three sections; demographics and medical school information, perceived usefulness of medical smartphone apps on a Likert Scaleand barriers to usage among students who do not have them installed. Results 97.9% of the total study population chose to participate in the study. There was roughly an equal percentage of responses from each clinical year and 72% of students reported active use of medical apps of which the vast majority (48%) have one to two apps on their phones. Only 39% of students felt that their medical colleges encourage the use of smartphone apps for academic purposes. 54% of students use apps to look up medical criteria for disease processes and almost 42% use them to search medications. On a Likert scale of 1-5, improvement of clinical performance received highest average score amongusers (3.92, SD 1.1), followed by quick access to medical guidelines (3.83, SD 1.0). The most common reasons for nonuse of medical apps were medical colleges not offering subscriptions and not knowing how to utilize apps. Conclusion Smartphone apps are widely used by clinical year medical students for academic purposes in our study. Despite lack of endorsement from their respective medical colleges, these apps are still popularly utilized for revision and research on disease criteria during clinics and rounds. Encouragement from the university has been identified as a significant barrier, however. Students who use smartphone apps reported an improvement in clinical performance overall; they were able to retrieve information quicker during rounds and noticed enhancements in formulating diagnoses and reading radiological images. In contrast, those not using these apps faced challenges with interpreting imaging results, recalling pharmacological properties of medicationsand developing differential diagnoses. Through these findings, we highlight the benefits of incorporating technological media into the undergraduate curriculum and hope medical universities from Pakistan can take inspiration.

Implementation of diagnostic stewardship in blood culture laboratory: a large-scale interventional study in a tertiary care hospital, South India

Background: Laboratories with well-established diagnostic stewardship program for culture and antimicrobial susceptibility test (C-AST) play a key role in guiding the clinicians to institute specific targeted therapy. Methods: The study period was divided into three phases; pre-intervention phase, intervention phase and post- intervention phase. During the pre-intervention phase, the blood culture was performed by conventional methods. During the intervention phase, immense efforts were made for full-fledged implementation of all the components of intervention-educational intervention for microbiology and clinical team and automations for culture, workflow modifications for performing preliminary tests in parallel with reporting, enhanced reporting frequency and stage-wise communication of reports to the clinicians. Results: There was a significant improvement in the isolation rate in the post-intervention phase (from 10.3% to 15.5%). There has been a steady decrease in mean turnaround time (TAT) of positive culture reports (from 85 to 45 h), which was in turn due to faster blood culture positivity, identification time and AST time. There was also significant improvement in clinical team performance on various parameters such as % of samples sent in pair, % of specimens with appropriate blood volume collected and % culture drawn before the antibiotic start. Conclusions: Our observation shows significant improvement in the pathogen isolation rate as well as performance of both microbiology and the clinical team. Most patients with sepsis are critically ill, therefore, it is the responsibility of every clinical microbiologist to implement the highest standard of diagnostic stewardship in blood culture laboratory.

Development of a new low-cost computer vision system for human gait analysis: A case study.

Today, human gait analysis is commonly used for clinical diagnosis, rehabilitation and performance improvement in sports. However, although previous research works in the literature address the use of motion capture systems by means of optoelectronic sensors, Inertial Measurement Units (IMUs) and depth cameras, few of them discuss their conception, guidelines and algorithms for measuring and calculating gait metrics. Moreover, commercially available motion capture systems, although efficient, are cost restrictive for most of the low-income institutions. In this research work, a new computer vision-based system (CVS) for gait analysis is developed and proposed. The aim is to close the gap found in the literature about the design and development of such systems by providing the requirements, considerations, algorithms and methodologies used to develop a gait analysis system with acceptable precision and accuracy, and at low cost. For this purpose, a linear computer vision method based on the non-homogeneous solution of the calibration matrix was used. The spatio-temporal and angular gait parameters were implemented in the proposed system, and compared with those reported in the literature. The denoising of the spatial gait trajectories and the strategies to detect gait events, are also presented and discussed. The results have shown that the proposed system is satisfactory for human gait analysis in terms of precision, computational performance and low cost.

Practice Gaps and Barriers in Optimal Care Among Healthcare Professionals Treating Patients with CLL and MCL with BTK Inhibitors: Results of a 2-Phase Qualitative/Quantitative Study

Background: Multiple BTK inhibitors (BTKis) are approved for treating patients with chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), with further approvals expected in the near future, increasing the clinical complexity of decision-making in patient care. This study sought to quantify knowledge and practice gaps among oncology healthcare professionals (HCPs) in the use of BTKis to treat patients with CLL and MCL, with the goal of informing the design of evidence-based education interventions aimed at addressing these gaps. Methods: From November 2021 - January 2022, 488 eligible HCPs (including physicians, physician assistants, nurse practitioners, and pharmacists) participated in a 2-phase study focused on knowledge and use of BTKis for CLL and MCL. Participants were required to be active practitioners who treated patients with CLL and/or MCL. In the exploratory qualitative phase of this study, 30 US participants completed a 45-minute telephone interview focusing on factors that influence clinical reasoning in selecting and providing treatment for CLL and MCL. Interviews were transcribed, and thematic analysis was performed. The quantitative phase of this study consisted of an online survey composed of multiple-choice questions and semantic differential rating scales. Respondents' answers to each question in the quantitative survey were compared with optimal answers as identified by treatment guidelines and specialists in CLL and MCL patient care. Results: Of responding HCPs, 59% were physicians, 64% had been in practice >10 years, 73% practiced in a nonacademic setting, and 73% cared for ≤10 patients with CLL and/or MCL per week. A group of 7 core practice gaps were identified through combined analysis of data from the qualitative and quantitative surveys; these included optimal therapy selection in the first- and later-line settings for CLL and MCL, awareness of mechanisms of resistance to approved BTKi therapy, and knowledge of investigational therapies and appropriate clinical trial referral. For example, of 270 responding HCPs, 47% were unable to select preferred first-line therapy (per expert recommendations) for a patient with CLL and high tumor burden and renal insufficiency, with 9% recommending a chemoimmunotherapy regimen. Likewise, a significant percentage of surveyed HCPs lacked confidence in their approach to therapy selection for patients with relapsed/refractory CLL or MCL, with optimal sequencing identified as a primary concern. Many HCPs were unfamiliar with BTKi mechanisms of action. Gaps in knowledge were particularly evident with novel BTKis, including pirtobrutinib, with 46% of online survey respondents uncertain about the noncovalent mechanism of this agent and only 33% aware that pirtobrutinib has shown activity in patients with CLL and disease progression on ibrutinib due to the appearance of a BTK C481 mutation. In total, 60% of respondents would not consider recommending a newly approved agent if they were not familiar with the class or mechanism of action of this agent. Conclusions: Many HCPs lack confidence and knowledge in applying optimal care for patients with CLL and MCL, particularly with regard to the use of BTKis, both in first- and later-line therapy. A lack of familiarity with promising novel BTKis under clinical investigation may lead to missed opportunities to enroll eligible patients on clinical trials and potentially delay integration of these agents into clinical practice as new indications emerge. Results of this study provide evidence to support the design of clinical tools, educational programs, and performance improvement interventions. Detailed findings will be presented, including group-specific analyses and investigation of the causalities of each of the identified practice gaps.

Perceptions and experiences of medical student first responders: a mixed methods study

ContextMedical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective.MethodsWe used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12.ResultsWe included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD – index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills.ConclusionMSFRs’ attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.

Visual Analytics to Leverage Anesthesia Electronic Health Record.

Visual analytics is the science of analytical reasoning supported by interactive visual interfaces called dashboards. In this report, we describe our experience addressing the challenges in visual analytics of anesthesia electronic health record (EHR) data using a commercially available business intelligence (BI) platform. As a primary outcome, we discuss some performance metrics of the dashboards, and as a secondary outcome, we outline some operational enhancements and financial savings associated with deploying the dashboards. Data were transferred from the EHR to our departmental servers using several parallel processes. A custom structured query language (SQL) query was written to extract the relevant data fields and to clean the data. Tableau was used to design multiple dashboards for clinical operation, performance improvement, and business management. Before deployment of the dashboards, detailed case counts and attributions were available for the operating rooms (ORs) from perioperative services; however, the same level of detail was not available for non-OR locations. Deployment of the yearly case count dashboards provided near-real-time case count information from both central and non-OR locations among multiple campuses, which was not previously available. The visual presentation of monthly data for each year allowed us to recognize seasonality in case volumes and adjust our supply chain to prevent shortages. The dashboards highlighted the systemwide volume of cases in our endoscopy suites, which allowed us to target these supplies for pricing negotiations, with an estimated annual cost savings of $250,000. Our central venous pressure (CVP) dashboard enabled us to provide individual practitioner feedback, thus increasing our monthly CVP checklist compliance from approximately 92% to 99%. The customization and visualization of EHR data are both possible and worthwhile for the leveraging of information into easily comprehensible and actionable data for the improvement of health care provision and practice management. Limitations inherent to EHR data presentation make this customization necessary, and continued open access to the underlying data set is essential.

Mid-Term Performance of the First Mass-Produced Three-Dimensional Printed Cementless Tibia in the United States as Reported in the American Joint Replacement Registry

BackgroundCementless tibial components have shown improvements in clinical performance compared to predicate designs, though evidence supporting mid-term performance and fixation is scarce. The purpose of this study is to determine the mid-term survivorships, revision rates, and reasons why 3-dimensional printed cementless tibial baseplates (3DTKAs) failed compared to other cementless as well as cemented tibial baseplates reported from the American Joint Replacement Registry (AJRR) data. MethodsAll primary total knee arthroplasty (TKA) cases performed in patients 65 years of age or older within the AJRR from January 2, 2012 through June 30, 2020 were queried. A total of 28,631 3DTKAs were identified from 428 institutions. These were compared to all other “aggregated cementless tibia” (n = 7,577) and “aggregated cemented tibia” (n = 550,133) cases. Centers for Medicare & Medicaid Services data over the same time period were merged with AJRR data to determine survivorship and patient-timed incident revision rates per 1,000 years. Failure reasons were tracked during this study period. ResultsAt 60 months, Kaplan-Meier implant survivorship was 98.9% (CI 98.7-99.0), 98.3% (CI 97.9-98.6), and 98.4% (CI 98.4-98.5) in the 3DTKA, aggregate cementless, and cemented knee cohorts, respectively (P < .0001). Patient-timed incident revision rates were 3.11 (CI 2.75-3.53), 3.99 (CI 3.34-4.76), and 3.35 (CI 3.28-3.42) for those cohorts, which corresponds to a revision rate of 0.31%, 0.40%, and 0.34% per year. ConclusionIn this analysis, 3DTKA had favorable survivorship and lower revision rates compared to aggregate cementless and cemented TKAs implanted from the same national database during the same time period.

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

BackgroundAudit and feedback is widely used in healthcare improvement, with evidence of modest yet potentially important effects upon professional practice. There are approximately 60 national clinical audit programmes in the UK. These programmes often develop and adapt new ways of delivering feedback to optimise impacts on clinical practice. Two such programmes, the National Diabetes Audit (NDA) and the Trauma Audit Research Network (TARN), recently introduced changes to their delivery of feedback. We assessed the extent to which the design of these audit programmes and their recent changes were consistent with best practice according to the Clinical Performance Feedback Intervention Theory (CP-FIT). This comprehensive framework specifies how variables related to the feedback itself, the recipient, and the context operate via explanatory mechanisms to influence feedback success.MethodsWe interviewed 19 individuals with interests in audit and feedback, including researchers, audit managers, healthcare staff, and patient and public representatives. This range of expert perspectives enabled a detailed exploration of feedback from the audit programmes. We structured interviews around the CP-FIT feedback cycle and its component processes (e.g. Data collection and analysis, Interaction). Our rapid analytic approach explored the extent to which both audits applied features consistent with CP-FIT.ResultsChanges introduced by the audit programmes were consistent with CP-FIT. Specifically, the NDA’s increased frequency of feedback augmented existing strengths, such as automated processes (CP-FIT component: Data collection and analysis) and being a credible source of feedback (Acceptance). TARN’s new analytic tool allowed greater interactivity, enabling recipients to interrogate their data (Verification; Acceptance). We also identified scope for improvement in feedback cycles, such as targeting of feedback recipients (Interaction) and feedback complexity (Perception) for the NDA and specifying recommendations (Intention) and demonstrating impact (Clinical performance improvement) for TARN.ConclusionsThe changes made by the two audit programmes appear consistent with suggested best practice, making clinical improvement more likely. However, observed weaknesses in the feedback cycle may limit the benefits of these changes. Applying CP-FIT via a rapid analysis approach helps identify strengths and remediable weaknesses in the design of audit programmes that can be shared with them in a timely manner.

Predicting Revalidation Examination Performance of Radiologic Technology Students: A Structural Equation Modelling Approach

One of today’s major problems in higher education system is the academic failure of medical science students with apparent yearly reports of experiencing probation, insufficient medical knowledge, increase educational semester, and drop out incidences. This study aims to predict the revalidation examination score of the Radiologic Technology interns of a higher education institution in Iligan City. An exploratory research with descriptive correlation design was used to investigate the interrelationship between the predicting variables in this study. The researchers adopted the Grit-S Scale structured questionnaire that was developed by Duckworth and Quinn (2009), which was designed to measure the grit level of respondents. This tool was used to elicit the needed primary data on the currently enrolled 26 radiologic technology interns at a higher institution in Iligan City. The survey was administered online via Google form. The secondary data, which constitutes of monthly examination score, case study scores, and revalidation examination was solicited in the CRT Program Head. Census sampling was employed in this research to obtain a more satisfactory response. The study showed that the indicators in monthly examination obtained a total mean of 31.64 with an SD of 14.35. These low scores were manifested in their performance in revalidation examination, which revealed a total mean score of 52.73 with a ± 16.02 SD. On the contrary, the respondents obtained high scores in case study with overall mean score of 95.42 and an SD of ± 2.83. The overall grit level of the respondents demonstrated a moderate description. Furthermore, the findings of this study also revealed that there is a significant relationship between monthly examination and revalidation examination. The strength of correlation is direct and strong as revealed by the coefficient of 0.904. Meanwhile, there is no significant relationship between revalidation examination score and case study score (p=0.537); between revalidation examination score and grit level (p=0.833); between grit level and monthly examination score (p=0.831) and between grit level and case study score (p=0.071). The positive influence of monthly examination implies that respondents who scored high in the monthly examination would be predicted to score high also in the revalidation examination. These findings can help the faculty and program head in drafting policies and the improvement of academic and clinical performance of students in revalidation exam.