Live Case Demonstrations Research Articles

Maternal and health care workers\u2019 perspectives on exclusive breastfeeding in the context of maternal HIV infection, in Busia county, western Kenya: a mixed methods cross-sectional survey

BackgroundWorld Health Organization recommends exclusive breastfeeding (EBF) for 6 months with maternal active antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT) of HIV. However, EBF in low resource settings remains low. We explored perspectives of EBF by HIV-infected mothers and health care workers in Busia County with a high prevalence of HIV to understand factors influencing the practice.MethodsA mixed methods cross-sectional survey using concurrent quantitative and qualitative data collection methods was conducted at PMTCT clinics. Data on socio-demography, young infant feeding practices, maternal and infant health was collected between February 2013 and August 2015 from 371 purposively sampled HIV-infected mother-infant dyads using a semi-structured questionnaire. Focus group discussions with mothers, in-depth interviews and passive observation of health care workers during interaction with mothers were conducted. Significance of difference between mothers practicing EBF or not was tested by Chi-square and Fisher’s exact tests setting significance level at 5%. Qualitative data was coded and content analyzed to generate themes.ResultsThree hundred and forty-nine (94%) mothers practiced EBF. Maternal comprehension of EBF to PMTCT of HIV influenced choice and practice of EBF (P value = 0.019 and < 0.001 respectively). Health care workers emphasized adherence to ART and offered nutritional supplementation during EBF. Health care workers’ nutritional counseling in the context of maternal HIV was poor. Mentor mothers shared their experiences with mothers and offered live case demonstrations of their successfully EBF, healthy and HIV-uninfected children. The main threats to EBF were teenage motherhood, low maternal education and working during EBF.ConclusionsEBF among HIV-infected mothers in Busia County, Kenya was high. Health education and counselling by health care workers, maternal comprehension of ART adherence to PMTCT of HIV, nutritional supplementation and mentor mothers’ peer counseling using live case demonstrations of HIV-uninfected EBF children promoted and sustained practice of EBF for 6 months. Teenage motherhood, low maternal education and having to work threatened EBF,

Live Case Demonstrations are Essential for the Success of Pediatric Urology Meetings in India.

Purpose:The purpose of the study was to survey the opinion of delegates attending national pediatric urology meeting regarding live case demonstrations (LCDs) to see whether these can be replaced with taped case demonstrations (TCDs) in future.Methods:A questionnaire-based survey was conducted at the end of the 3-day annual conference and live operative workshop in pediatric urology. Apart from general data such as age of the respondent and type of practice setting, four key questions on LCDs with yes/no responses included: would you have attended this meeting if there were no LCDs? Are unedited videos (TCDs) as effective as LCDs for teaching? Do you think LCDs should be continued? Would you allow your child to be operated in LCD by an expert? For question 3, the outcomes were compared between junior surgeons (<45-year-old) and senior surgeons (>45-year-old).Results:On analysis, 88/140 (62%) respondents (95% confidence interval [CI]: 54%–70%) said that they would not have attended the meeting if there were no LCDs; 70/139 (50%) respondents (95% CI: 42%–58%) felt that TCDs may be an effective alternative to LCDs; 129/144 (90%) respondents (95% CI: 83%–94%) felt that LCDs should be continued. For question 4, 101/129 (79%) said they would allow their child to be operated in LCD by an expert, while 28 (21%) did not agree for their child to be operated in LCD. There was no significant difference between junior and senior surgeons regarding support for LCDs (P = 0.15).Conclusions:In the Indian scenario, LCDs were favored as an essential part of pediatric urology meeting, attract more participation, and are likely to be important for the success of the meeting.

Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience.

PurposeLive case demonstrations have become a common occurrence at surgical meetings around the world. These demonstrations are meant to serve as an educational medium for teaching techniques, promote discussion, improve interventions and outcomes. Despite the valuable educational benefits, many authors still question the ethics of this approach. We present our 8-year experience in live surgery, discuss the ethical issues, and provide recommendations.Materials and MethodsWe reviewed records of patients who underwent live robotic surgery during broadcasting events. Procedures performed were robot-assisted laparoscopic pyeloplasty (RAL-P), ureteral reimplantation (RALUR), and hemi-nephrectomy (RAL-HN). Peri- and post-operative outcomes were compared to our previously published case series.ResultsFrom October 2011 to May 2019, the senior author (MSG) performed all live surgery demonstrations on 22 patients: 9 RAL-P, 9 RALUR, and 4 RAL-HN. Live RAL-Ps had a 100% success rate and lower 30-day Clavien-Dindo grade (CDG) III complications when compared to our previous case series (11.1% vs. 21.2%). RALURs performed during live demonstrations had a higher success rate than our previously published cohort (100% vs. 82%). RAL-HN operative time and length of stay were comparable to our non-live control group.ConclusionsLive surgery is a valuable didactic tool, but even experienced surgeons may be adversely affected by inappropriate case selection, technical difficulty, and anxiety associated with particular settings, such as operating at different institutions or working with unfamiliar surgical teams. We suggest consultation of an ethics review board and formulation of standard guidelines for patient selection, surgical equipment, and operative team.

Percutaneous patent foramen ovale closure during live case demonstrations.

Live case demonstrations serve as an educational tool for interventional techniques in cardiology. The aim of this study was to assess the safety and technical success of percutaneous patent foramen ovale (PFO) closure during live case demonstrations. All patients who had undergone percutaneous PFO closure with Amplatzer devices during live case demonstrations at our institution were consecutively included in this retrospective analysis. Procedure related events were compared with summary event rates derived from the eight randomized controlled trials (RCTs) investigating PFO closure, as well as with a propensity matched cohort of patients treated under usual conditions. From April 2004 to June 2015, 142 patients underwent percutaneous PFO closure during live demonstrations, mainly for secondary prevention of cryptogenic cerebrovascular events. The interventions were fluoroscopy guided and successful in all but three cases (2%). Minor adverse events occurred in nine patients (6%). Contrast TEE performed at about 6 months showed complete closure in 84%. No significant differences with regard to technical success and major complications rate were found compared to RCTs, except for an increased rate of minor bleeding observed during live case demonstrations (P for difference < 0.001), mainly attributable to concomitant arterial access for incidental coronary angiography performed in 70% of patients. Except for slightly longer procedure duration, no difference was found compared to a matched population treated under usual conditions. Percutaneous PFO closure can be performed during live case demonstrations with the same high technical success as during routine cases.

Analysis of Patient Safety and Outcomes of Live Case Demonstrations in Endoscopic Skull Base Surgery

Analysis of Patient Safety and Outcomes of Live Case Demonstrations in Endoscopic Skull Base Surgery

Training in endoscopic ultrasonography: An Asian perspective.

Training of endoscopic ultrasonography (EUS) in Asia faces two major challenges: (i) the ever-increasing demand for skills to handle a growing range of interventional EUS procedures; and (ii) a continual shortage of EUS training programs. As the therapeutic application of EUS continues to expand, the need to train more new endosonographers and upgrade skills of existing ones has become more critical than ever before. A formal fellowship to acquire EUS knowledge and skills in an advanced endoscopy center has always been perceived as the best way of training novices, but such opportunities remain limited in most Asian countries. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. Such programs are generally intensive and may combine didactic lectures, live-case demonstrations, and hands-on training on phantoms, or live animal models for teaching. Although not as rigorous as conventional full-time EUS fellowships, such short-term programs are not necessarily inferior in quality. With courses offered from basic to advanced levels, and at regular intervals, busy practising endoscopists have the flexibility to attend the course that best matches their individual levels of experience, learn at their own pace and acquire EUS knowledge and skills over as many courses as desired. This open-ended progressive learning model is more agile than established fixed-term learning models and is expected to adapt better to future needs.

Safety of Live Case Demonstrations in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion

The data regarding the risk and benefits associated with live demonstrations at interventional cardiology congresses are scarce and controversial. We aimed to assess the clinical safety of chronic total occlusion percutaneous coronary intervention (CTO-PCI) procedures during live demonstrations. From January 2008 to December 2013, 739 consecutive patients underwent CTO-PCI at our center, and 199 patients were scheduled to undergo live CTO-PCI demonstrations at cardiology congresses that were globally transmitted to international meetings. The baseline characteristics, procedural complications, and clinical outcomes were compared between the live demonstration group and nonlive demonstration group. The procedural success rates were similar in the live demonstration group than in the nonlive demonstration group (91.5% vs 86.7%, p= 0.076), although the CTO lesions were longer and more tortuous in the live demonstration group (p= 0.029, p= 0.022, respectively). No cases of 30-day mortality were noted in the live demonstration group (0% vs 0.7%, p= 0.28), and no significant differences in procedural complications, such as coronary dissection, coronary perforation, and cardiac tamponade, were observed between the groups (p= 0.53, p= 0.12, and p= 0.40, respectively). The survival rates were similar in the 2 groups at a median follow-up duration of 51.2 ± 28.9months (log-rank test: p= 0.45). Compared with cases of unsuccessful CTO-PCI, the cases of successful CTO-PCI exhibited improved all-cause survival in both the live and nonlive demonstration groups (log-rank test: p= 0.045, p= 0.0056, respectively). In conclusion, we found that procedural and clinical outcomes of live demonstration CTO-PCI were not significantly different compared with cases undergoing routine CTO-PCI procedures.

Live-case demonstrations: putting patients first.

Live-case demonstrations have become essential teaching tools. Debate about their added educational value and risk-benefit considerations vis-à-vis patient safety demand that major interventional cardiology meetings offering live-case demonstrations carefully define and monitor the objectives and quality of the cases included at their meetings. To this end, Europa Organisation, the content-providing group that supports EuroPCR and other PCR conferences internationally, has convened the PCR VITAL-Live Workshop, bringing together senior interventional cardiologists and experienced live-case operators with the aim of defining and reviewing the key components and goals of valuable live-case demonstrations. The Vital-Live participants unanimously agreed that live cases provide an educational experience with an immediacy and intensity that is unmatched by taped cases, through audience engagement with unfiltered reality and participation in real-time decision-making. Best practices regarding case selection, preparation, objectives, delivery, and discussion of the demonstrations were designed to ensure that the lessons learned would be clear and implementable by audience members, leading to improved patient care and safety in their own practices. Today's on-line accessibility of live-cases underscores the need for operators, hospitals, panels, and meeting chairs to insure that the content, quality, and intent anticipate any public scrutiny. This requires putting patient outcomes first, both at the level of the live demonstration itself and its broader educational worth.

The surgical spectacle: a survey of urologists viewing live case demonstrations

The surgical spectacle: a survey of urologists viewing live case demonstrations

The surgical spectacle: a survey of urologists viewing live case demonstrations

To evaluate perspectives of urologists viewing live case demonstrations (LCD) and taped case demonstrations (TCD). A 15-question anonymous survey was distributed to attendees of the live surgery session at the American Urological Association 2012 national meeting (Atlanta) and the second International Challenges in Endourology meeting (Paris). Of 1000 surveys distributed, 253 were returned completed (response rate 25%). Nearly half of respondents were in the academic practice setting and nearly 75% were beyond training. Just over 30% had performed a LCD previously. The perceived benefit of an LCD was greater than unedited and edited videos (chi-squared P = 0.014 and P < 0.001, respectively). Nearly no one selected 'not helpful' and a few selected 'minimally helpful' for any of the three forms of demonstration. Most respondents identified that opportunity to ask questions (61%) and having access to the full unedited version (72%), two features inherent to LCD, improved upon the educational benefit of edited videos. Most (78%) identified LCD as ethical. However, those that did not perceived lower educational benefit from LCD (P = 0.019). A slim majority (58%) would allow themselves or a family member to be a patient of a LCD and the vast majority (86%) plan to transfer knowledge gained at the LCD session into their practice. Urologists who attended these LCD sessions identified LCDs as beneficial and applicable to their practice. LCDs are preferred over videos. The large majority considers LCD ethical, although not as many would volunteer themselves for LCD. Further studies are necessary to determine if there is actual benefit from LCD over TCD to patient care.

Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. We conducted four CME seminars in 2007-2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720 × 480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Videoconferences are excellent channels for CME programs associated with laparoscopic training.

IPEG Survey on Live Case Demonstrations in Pediatric Surgery

Live case demonstrations (LCDs) represent a common educational method throughout most surgical specialties. Concern has been raised about ethics and patient safety. The surgeon's elevated stress level, the need to comply with the meetings' time schedules, unfamiliar surgical equipment, and questionable indications resulted in prohibition of LCD in some surgical societies. We aimed to investigate the opinion of International Pediatric Endosurgery Group (IPEG) members on LCD. An online-based survey in 2010-2011 requested all IPEG members to complete a questionnaire including data on personal background and statements on LCD. Participants had to indicate agreement with statements on a scale from 1 (do not agree) to 5 (fully agree). Sixty-one surgeons and 148 attendees completed the questionnaire. Eighty-three percent of surgeons indicated elevated stress levels during LCD. Surgeons (3±1.2) and attendees (3±1.4) agreed that LCD may be harmful. Surgeons (2±1.2) and attendees (2±1.3) disagreed that LCD may be beneficial for patients. However, LCD was rated as educationally essential by surgeons (3±1.3) and attendees (3±1.3). Surgeons agreed (3±1.2) that educational benefits of LCD outweigh disadvantages for patients; attendees did not agree (2±1.3). Surgeons (4±1.4) and attendees (3±1.4) agreed that LCD should continue. Nevertheless, 36% of surgeons and 52% of attendees would not consent for LCD in their own child. LCD is regarded an essential part of surgical education by IPEG members. However, it represents a controversial topic. The majority of IPEG members appear willing to continue LCD. If IPEG decides to go on with LCD, attention has to be drawn to patient safety and ethical considerations.

Patient Safety and Outcomes From Live Case Demonstrations of Interventional Cardiology Procedures

The goal of this study was to examine the safety and results of interventional procedures performed during the broadcast of live case demonstrations. Professional meetings using live case demonstrations to present cutting-edge technology are considered a valuable educational resource. There is an ongoing discussion on whether patients who are treated during live case demonstrations are exposed to a higher risk. Between 1998 and 2010, 101 patients were treated during live transmissions from a single center in 15 invasive-cardiology conferences. Technical success was defined as the ability to effectively perform the planned procedure without any major complication. The primary endpoint of the study was the composite occurrence of death, myocardial infarction, or stroke. The interventional procedures included coronary (n=66), carotid (n=15), peripheral (n=1), valvular (n=2), congenital heart disease (n=12), and complex electrophysiological mapping and ablation interventions (n=7). In 4 cases, the intended procedure was not done. The procedure was technically successful in 95%. In 5 cases, the procedure was unsuccessful because of the inability to cross a chronic total occlusion. There were no deaths during the hospital stay, and the composite primary endpoint occurred in 2 patients: a minor stroke following an atrial fibrillation ablation and a rise in serum troponin levels after percutaneous coronary intervention. These results were no different from those of 66 matched controls who underwent procedures performed by the same operators but not as live case demonstrations (relative risk: 0.32; 95% confidence interval: 0.02 to 3.62, p=0.62). In this consecutive series of interventional cardiology procedures that were performed by expert operators during live demonstration courses, the procedural and 30-day clinical outcomes were similar to those found in daily practice and to those that have been reported in the contemporary published data. These results suggest that broadcasting live case demonstrations in selected patients from selected centers may be safe.

Live Case Demonstrations: Attitudes and Ethical Implications for Practice

Live case demonstrations (LCDs) are now prevalent in medical education courses despite ethical concerns including that they may expose patients to undue risk. However, there are limited data regarding many aspects of LCDs to help inform policies and guidelines regarding them. We conducted an Internet-based survey of clinicians who have served as faculty or attended the 2009 and 2010 professional meetings sponsored by VIVA (Vascular Interventional Advances). There were 106 VIVA 2009 respondents and 165 VIVA 2010 respondents. Observing an LCD was more valuable than watching a prerecorded video for most (70% in 2009; 82% in 2010) respondents. About one-third of respondents thought that LCD patients are exposed to more risk than non-LCD patients. Respondents who had been operators were more likely to agree that LCD patients are exposed to more risk (p = 0.001 in 2009; p= 0.022 in 2010). Approximately one-third of respondents in 2009 and one-half in 2010 thought that patients experience direct medical benefit in an LCD. The majority (71% in 2009; 76% in 2010) indicated that they would support the decision of a family member or friend to be an LCD patient, few (44% in 2009; 58% in 2010) indicated that they personally would agree to be an LCD patient. This survey provides new insights into the value and risk of LCDs. Obtaining the perspective of patients would be extremely valuable in helping to ensure that the ethical aspects of LCDs are addressed properly and thoroughly.

Live case demonstrations: patient safety, ethics, consent, and conflicts

Live case demonstrations: patient safety, ethics, consent, and conflicts

CardioPulse Articles * Cardiology Update 2011: an ESC Update Programme Davos Switzerland, 13-18 February 2011 * A Code of Conduct is published for live case demonstrations * Personal experiences of emigre physicians and families * Following one's heart: shifting cultures to practice cardiology * Thermography is providing new insights into the pathophysiology of disease * People's corner: promotion * Paolo

CardioPulse Articles * Cardiology Update 2011: an ESC Update Programme Davos Switzerland, 13-18 February 2011 * A Code of Conduct is published for live case demonstrations * Personal experiences of emigre physicians and families * Following one's heart: shifting cultures to practice cardiology * Thermography is providing new insights into the pathophysiology of disease * People's corner: promotion * Paolo

SCAI/ACCF/HRS/ESC/SOLACI/APSIC Statement on the Use of Live Case Demonstrations at Cardiology Meetings

Patient-based teaching has been used since the earliest days of medical education and continues to be used today for educating medical students, physicians, nurses, and other medical personnel. Patient demonstrations have evolved from bedside teaching, to the surgical amphitheater, to recorded medical procedures, and finally to broadcast live case demonstrations. With current telecommunication capabilities, it is possible to transmit medical procedures worldwide in real-time. Because of their perceived educational benefit and in parallel with advances in transmission technology, the use of live case demonstrations at medical meetings has grown to include adult and pediatric interventional and electrophysiology procedures. Many feel live broadcasts are an effective educational tool, especially for new technical procedures that cannot be learned by self-study or didactic presentations. However, as live case transmissions have proliferated, issues have been raised about patient safety, the ethics of live broadcasts, and their value as an educational tool. Both interventional cardiology and electrophysiology are rapidly evolving fields with changing educational needs, and many of the cases transmitted focus on newer therapies that have not been formally tested in randomized trials. The repeated demonstration of untested therapies has the potential to dilute their educational value and lead physicians into believing the therapy is advantageous in the absence of appropriately controlled clinical trials. This educational approach may not be an appropriate model for advancing patient care. Cases that feature unapproved new devices may be interpreted as more promotional than educational. Live demonstrations of endoscopy, bronchoscopy, and dental procedures are being done, but there are no published guidelines from the related professional societies [1–3]. The American Association for Thoracic Surgery and the Society of Thoracic Surgery has published a statement on live broadcasts of thoracic and cardiovascular surgery [4]. Broadcasts to the general public were prohibited, recorded broadcasts, either edited or unedited, were deemed preferable to live surgery broadcasts and they recommended national and international cardiothoracic societies consider prohibiting live broadcasts to large audiences at their annual meetings. Because of the growth of live case transmissions and these concerns, the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology Foundation (ACCF), the Heart

Interventional cardiology live case presentations: Regulatory considerations

Live case presentations are increasingly common at interventional cardiology conferences. Taking advantage of significant advances in communication technology, broadcasts of procedures can be viewed as an extension of traditional medical education targeted to large groups of practitioners. However, there are important ethical, commercial, and patient safety issues associated with live cases that deserve attention. Use of investigational devices in live case demonstrations is subject to review and approval by FDA's Center for Devices and Radiological Health (CDRH), and the outcomes of patients participating in live cases are considered in the overall clinical study results. This article discusses CDRH's regulatory view of live case presentations with a focus on patient safety, clinical trial integrity, and concerns regarding improper medical device promotion.

Interventional Cardiology Live Case Presentations

Live case presentations are increasingly common at interventional cardiology conferences. Taking advantage of significant advances in communication technology, broadcasts of procedures can be viewed as an extension of traditional medical education targeted to large groups of practitioners. However, there are important ethical, commercial, and patient safety issues associated with live cases that deserve attention. Use of investigational devices in live case demonstrations is subject to review and approval by FDA's Center for Devices and Radiological Health (CDRH), and the outcomes of patients participating in live cases are considered in the overall clinical study results. This article discusses CDRH's regulatory view of live case presentations with a focus on patient safety, clinical trial integrity, and concerns regarding improper medical device promotion.

SCAI/ACCF/HRS/ESC/SOLACI/APSIC statement on the use of live case demonstrations at cardiology meetings

reamble atient-based teaching has been used since the earliest days of edical education and continues to be used today for educating edical students, physicians, nurses, and other medical peronnel. Patient demonstrations have evolved from bedside eaching, to the surgical amphitheater, to recorded medical rocedures, and finally to broadcast live case demonstrations. ith current telecommunication capabilities, it is possible to ransmit medical procedures worldwide in real-time. Because f their perceived educational benefit and in parallel with dvances in transmission technology, the use of live case emonstrations at medical meetings has grown to include adult nd pediatric interventional and electrophysiology procedures. any feel live broadcasts are an effective educational tool, specially for new technical procedures that cannot be learned y self-study or didactic presentations. However, as live case ransmissions have proliferated, issues have been raised about atient safety, the ethics of live broadcasts, and their value as n educational tool. Both interventional cardiology and elecrophysiology are rapidly evolving fields with changing eduational needs, and many of the cases transmitted focus on