On-site Training Research Articles

On-site training using JMTR and related facilities in FY 2016

On-site training using JMTR and related facilities in FY 2016

Cancer registration challenges in low- and middle-income countries-the case of the Pacific Islands.

Cancer registration challenges in low- and middle-income countries-the case of the Pacific Islands.

Modular Smart Production Lab

Complex and fast changing production processes represent a major challenge for universities, since appropriate didactic concepts for authentic reaching methods are necessary. Especially digitalization and the interaction of interdependent disciplines are difficult to comprehend. The modular smart production lab has been developed precisely for the education of the industrial engineers of tomorrow. The modular production system of Festo is used within a new competence-oriented didactic concept. A learn repository forms basis for individual teaching paths for different competence levels. The resulting MSPL enables quasi on-site interdisciplinary training for industrial engineers. A great advantage of the MPSL is its flexibility towards changing process requirements. Furthermore, it serves as R&D infrastructure for the development of new I4.0 case studies. Hence, this development allows qualifying students for their future jobs.

“The Effect of Postural Education on Decreasing the Severity of Neck Pain in Female School Teachers: A Prospective Cohort Study”

BACKGROUND: Musculoskeletal Disorders includes a wide range of inflammatory and degenerative conditions affecting the muscles, ligaments, tendons, nerves, bones and joints and it can occur from a single or cumulative trauma. Pain and physical disability brought about by MSD affects social functioning and mental health, further diminishing the teacher’s quality of life . A systematic review published in biomed central shows the prevalence of work related musculoskeletal disorders to be 39 % - 95 % in school teachers. Neck pain is reported to be 7th most prevalent pain site which is 68.9 % prevalent in school teacher. OBJECTIVES: The objective of the study was to find out the effect of postural education on decreasing the severity of neck pain in female school teachers. METHODS: 180 female primary and secondary school teachers aged 25 – 35years were conveniently selected for the study. Baseline survey: Teachers were asked to note down their neck pain using NPRS & NDI. Postural education programme : teachers received a lecture based on ergonomic training and occupational health education. Follow up survey : After 3months teachers were asked to note down their level of neck pain using NPRS & NDI after following the protocol. There were 20 drop outs in the study. RESULTS: There was a significant reduction in mean values of NPRS in baseline and follow up 25.44 – 17.6 respectively also NDI mean values 25.11 - 21.16 baseline and follow up respectively. After the intervention, teachers found the postural education programme to be effective in reducing the neck pain. CONCLUSION: Interventions based on occupational health education lectures, on-site ergonomics training, publicity brochures and posters showed a positive effect on prevention and control of the occurrence of work-related musculoskeletal disorders in teachers. KEYWORDS: Neck pain, Work related musculoskeletal disorders, Postural education.

Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial

IntroductionHypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from...

Implementation of Surgery Clinical Pathway for Training in Urologic Robotic Surgery: Preliminary Experience with the Radical Prostatectomy in Central America

1.1.Objective: Robotic surgery for urologic disease is becoming increasingly widespread. However, there is a known learning curve for this technology that can inhibit its adoption; this concern may be particularly important in an international, non-academic setting. Our institution introduced the first robotic system in our geographic region (Central America), and we reviewed our experience in implementing a training pathway for urologic robotic surgery, especially in radical prostatectomy. 1.2.Methods: In March 2012 a da Vinci SI robotic system was installed at a private hospital in Panama; this was the first system installed in Central America. Our implementation pathway was comprised of an online virtual course, video reviews, on-site surgical system training, off-site Surgical skills training using animate and inanimate models, off site Live Procedure Observation, and on site surgery with an experienced preceptor. We prospectively tracked intra-operative. 1.3.Parameters: Time for patient preparation, docking of the robot, and console time. We also reviewed early patient results for radical prostatectomy. 1.4.Results: During a 48 month period, 500 robotic-assisted laparoscopic surgeries were performed. 210 urology cases included: 118 radical prostatectomies, 31 partial nephrectomies, 20 radical nephrectomies, 4 donor nephrectomy, 17 pyeloplasties, 3 sacrocolpexias, and 1 partial cystectomy. All surgeons complete the clinical pathway solution. Mean console time for the first 8 cases, with preceptor, was 251 minutes and for the following 31 cases 110 minutes. Regarding robotic-assisted laparoscopic radical prostatectomies: patient preparation was 17 min, docking time 5.6 min, console time 150 min. Total operative time range from 2 to 5 hours (Mean 210 minutes). Mean patient age was 61. Mean PSA 8 ng/ml. Average hospitalization days: 2,7 (range 1-14d). The dominant preoperative Gleason was 3 + 3, while the predominant postoperative was 4 + 3. There were no intraoperative major complications. 1.5.Conclusion: Our structured clinical training program assisted in the rapid development of our robotic surgical program, and we believe was responsible for our safe and effective experience. As robotic surgery continues to expand to diverse international regions and non-academic institutions, detailed protocols such as ours can aid in its successful adoption elsewhere, as well.

Environmental Impact of Energetics on Test Ranges

AbstractIn recent years, pollution of environmental components onsite training and test ranges has drawn attention of governments and defence ministries. In a great number of NATO and EU countries, measures have been taken including an assessment of test ranges status and their pollution content. A number of researches have been conducted in this area and their results have been published. Most of them comprise disturbing data on the measured contamination levels of explosives and heavy metals in soil and groundwater. This qualifies the problem on management of sites contamination with munitions constituents as a serious one and of international concern.

Improvement of Hand Hygiene Quality and Compliance Using Bioburden Measurement and Online Feedback in Germany.

To improve compliance with hand hygiene, a novel method with inclusion of an online reporting system was developed, comprising measurement of total hand bioburden, anonymous online feedback, and onsite training. The intervention significantly improved both compliance and quality of hand hygiene and reduced Staphylococcus aureus incidence. Infect Control Hosp Epidemiol 2016;1-4.

Results from a Train-the-Trainer Communication Program for Oncology Nurses.

26 Background: Oncology nurses working across the cancer continuum need communication tools in order to navigate between oncology and palliative care for the benefit of patients and their families. An evidence-based communication training course funded by the National Cancer Institute and identified by the acronym COMFORT was provided to 187 oncology nurses across the nation. Launched in 2015, it is the first train-the-trainer communication training course for nurses and addresses communication across the cancer continuum. Methods: The curriculum, emphasizing team communication, teaches nurses how to provide life-altering news, assess patient/family health literacy needs, practice mindful communication, acknowledge family caregivers, and address communication openings and goals. The curriculum covers the continuum of cancer care (diagnosis, treatment, survivorship, recurrence, end of life). Two courses were held and participants were contacted at six months for follow-up evaluation. Results: Course participants reported teaching an additional 2,460 healthcare providers, primarily nurses (1,961) and physicians (264). On average, each participant trained 21 nurses and two physicians. The training manual, which was provided during the course, was used by 81% of course participants and was rated as effective (7.71 out of 10). The most commonly taught curriculum modules were Communication (25.5%), Mindful Communication (22.3%), Team Communication (18.5%), and Family Caregivers (11.4%). Course participants reported that their institution were most effective with communication during treatment (7.21 out of 10) and least effective communication occurred during bereavement (5.02), at time of death (5.97), through survivorship (5.63), and with patients facing end of life (6.09). Conclusions: The train-the-trainer model for communication training appears to be a viable and promising strategy for broadly teaching communication across the cancer continuum. Train-the-trainer is less costly than traditional on-site training methods and allows instruction to be tailored to address the institution’s least effective communication practices across the cancer continuum.

Immunology's Twinning Triangle

Immunology's Twinning Triangle

SAFETY AND HEALTH SITE INSPECTIONS FOR ON-FIELD RISK ANALYSIS AND TRAINING

The field of construction is always affected by a large number of accidents at work that have many different causes and responsible. Therefore, it is of utmost importance to focus on all these issues, in order to reduce all risk factors that can undermine individuals’ safety on building sites. The objective of the research is then the development of a method for quick on site analysis of all critical issues that can create accidents and identification of the related causes in order to directly provide a correct and focused training identified as the best method to act on the causes to reduce accidents. The research was carried on during construction of the Universal Exhibition of Milan – Expo 2015 – that counted almost 70 contemporary construction sites. To reach the goals further research steps has been followed and in particular: (i) inspections on building sites through all the Expo area; (ii) analysis of the main identified problems; (iii) development of a methodology to quickly identify the cause of problems; (iv) validation of the method through back office analysis of site documents; (v) correct on-site training according to found problem. During the whole construction site, the improvements in criticalities solving have been visible thanks to the focused training. The developed method, carried on in a high-risk environment, is applicable in any other building sites and environment as independent from the boundary conditions of the place.

How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis

Local Mentor: Stephanie Teal, MD, MPH ASL Advisor: Nancy Hueppchen, MD, MSc PURPOSE: To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions. BACKGROUND: OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services. METHODS: We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved. RESULTS: 15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&Cs and/or inpatient D&Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities. DISCUSSION: OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.

Patients Without Borders: Using Telehealth to Provide an International Experience in Veterinary Global Health for Veterinary Students.

There is an increasing need to produce veterinarians with knowledge and critical thinking skills that will allow them to participate in veterinary global health equity delivery, particularly in the developing world, where many people remain dependent on animal-based agriculture for a living. This need for veterinarians trained in global health is reflected by the demand among students for greater exposure and education. At the same time, many students are held back from on-site training in global health due to constraints of cost, time, or family obligations. The purpose of this article is to describe the use of a telemedicine approach to educating veterinary students at Tufts Cummings School of Veterinary Medicine. This approach simultaneously provides expert consultation and support for a pro bono hospital in the developing world. The development of a telemedicine teaching service is discussed, from initial ad hoc email consultation among friends and associates to a more formal use of store-and-forward delivery of data along with real-time videoconferencing on a regular basis, termed tele-rounds. The practicalities of data delivery and exchange and best use of available bandwidth are also discussed, as this very mundane information is critical to efficient and useful tele-rounds. Students are able to participate in discussion of cases that they would never see in their usual clinical sphere and to become familiar with diagnostic and treatment approaches to these cases. By having the patient "virtually" brought to us, tele-rounds also decrease the usual carbon footprint of global health delivery.

Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories.

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9-2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine-Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

The “train as you fight” concept: Applicable for in-hospital resuscitation training?

Background: Motivating caregivers for CPR and recognition of the potentially threatened patient provider and refresher courses, especially if they have a low potential exposure rate, is difficult. Solutions run from mass training to individual, computer-guided schemes. Historically, the grouping technique has primarily been on level of training (BLS, ALS) to be given. But, particularly under in-hospital conditions, ad hoc ‘teams’ (i.e. secretaries, nurses and doctors) will work together until a resuscitation team arrives when a patient collapses. We instituted a combined multi-level, on-site training scheme to evaluate if such in-company team training (“train as you fight”) would be beneficial to teaching results.

Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July–September 2014

The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city. First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed. The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late. The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome.

Learning Outcome Measurement in Nurse Participants After Disaster Training.

The National Disaster Health Consortium is an interprofessional disaster training program. Using the Hierarchical Learning Framework of Competency Sets in Disaster Medicine and Public Health, this program educates nurses and other professionals to provide competent care and leadership within the interprofessional team. This study examined outcomes of this training. Training consisted of a combination of online and on-site training. Learning outcomes were measured by using the Emergency Preparedness Information Questionnaire (EPIQ) pre/post training and participant performance during live functional exercises with the use of rubrics based on Homeland Security Exercise and Evaluation principles. A total of 64 participants completed the EPIQ before and after training. The mean EPIQ pre-training score of 154 and mean post-training score of 81 (reverse-scored) was found to be statistically significant by paired t-test (P<0.001). Performance was evaluated in the areas of triage, re-triage, surge response, and sheltering. Greater than 90% of the exercise criteria were either met or partially met. Participants successfully achieved overall objectives in all scenarios. Disaster response requires nurses and other providers to function in interprofessional teams. Educational projects, like the National Disaster Health Consortium program, offer the potential to address the need for a standardized, interprofessional disaster training curriculum to promote positive outcomes. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

MHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana.

There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA). During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging-supported VIA training by an expert VIA reviewer. Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen κ statistic was 0.67 (95% CI = 0.45-0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services. Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.

A key traumatic brain injury initiative in India

A key traumatic brain injury initiative in India

PTH-134 Setting Up An Endoscopy Unit in Northern Malawi

Introduction There is a major need for endoscopic services in Malawi due to the very high incidence of both variceal bleeding related to schistosomiasis and gastro-oesophageal cancer. The availability of facilities and trained staff to perform variceal band ligation (VBL) and endoscopic stent insertion would benefit local patients. The aim of this project was to set-up an endoscopy unit at Mzuzu Central hospital (MCH), the regional hospital in Northern Malawi, which serves a population of approximately 2 million. Methods After an initial assessment visit, four on-site training visits (two accompanied by endoscopy nurse trainers) were undertaken by a UK endoscopy trainer between 2012–2015. Endoscopy equipment was donated and shipped out from Glasgow. The local endoscopists and endoscopy nurses also attended formal endoscopy training courses at the recognised regional training centre in Blantyre. Malawi-adapted DOPS and unit GRS were undertaken and numbers of procedures audited. Results During this period, six donated endoscopes and many accessories were delivered to MCH. Local clinicians and nurses had four weeks of on-site intensive training and attended five formal training courses. Skills in diagnostic endoscopy and VBL were taught and there was an introduction to stent insertion. A total of 20 DOPS were undertaken showing a gradual improvement in endoscopic skills. The unit GRS assessment improved with regard to patient consent, clinical monitoring, reporting and audit. A nine-month audit of consecutive endoscopic procedures at MCH revealed either varices or upper GI cancer in 28% cases. Over the total study period, the annual number of endoscopies undertaken at MCH increased from 108 to 376, with VBL cases increasing from 17 to 51. Conclusion A functioning endoscopy unit has been set up at MCH with introductory skills provided to local endoscopists and nurses, by both on-site training and attendance at formal training courses. Advanced training of more endoscopists in therapeutic endoscopy and ongoing equipment support is required to ensure the unit becomes sustainable. Disclosure of Interest None Declared