Post Session Research Articles

Assessing utility of a simple low-cost simulator model to improve direct ophthalmoscopy skills amongst medical students

Abstract Background Ophthalmoscopy is an essential skill for medical trainees, however, trainees commonly report feeling uncomfortable with this skill. The purpose of this study is to determine the utility of a low-cost simulator in improving medical student’s comfort and proficiency with direct ophthalmoscopy. Methods An easy to assemble simulator was constructed using low-cost materials. First and second year medical students at the University of British Columbia were recruited. Participants in the Simulator group completed a survey to rate their competency using a direct ophthalmoscope prior to a practice session with the simulator. The Control group had no simulator session. Both groups then took part in the regularly scheduled clinical session and were assessed by a preceptor on their proficiency using an evidence-based rubric. The Simulator Group completed a post session survey about their perceived proficiency with an ophthalmoscope. Results The Simulator group had 14 participants and the Control group had 103 participants. Participants in the Simulator group self-reported significant increases (p < 0.05) in their perceived competence across all domains surveyed including overall comfort and visualizing the optic disc. There were no significant differences in proficiency rated by a preceptor between the Simulator and Control groups (7.21 vs 7.06 out of 10; p = 0.572). Conclusions This study demonstrates that a low-cost simulator is an accessible and valued method for improving student’s perceived competence and comfort in ophthalmoscopy. While this study did not show the simulator results in higher proficiency, rated by an evaluator, future studies can focus on more robust measures of skill acquisition and larger sample size.

Bearing witness: Medical education and reflecting on the Holocaust then and now.

Despite advocacy from the Association of American Medical Colleges (AAMC) and The Lancet Commission on medicine, Nazism, and the Holocaust, Holocaust education is lacking in medical education. To address this gap, students at Geisinger Commonwealth School of Medicine (GCSOM) viewed an Association of American Medical College (AAMC) webinar about medicine during the Holocaust as part of the required curriculum for first year medical students introduced in 2022. As part of their doctoring course, Physician and Patient Centered Care (PPCC), students viewed the AAMC webinar "The legacy of the role of medicine during the Holocaust and its contemporary relevance" and participated in two structured reflections: a written reflection on how webinar topics inform students' professional development and a verbal reflection on learning from the Holocaust to develop a sense of moral courage, advocacy, and activism in medicine. Researchers conducted qualitative analysis of written reflections and analyzed session surveys to determine key themes and impact of the session. Of the 108 enrolled in PPCC, 59 (54.6%) completed a post session Likert scale survey assessing the impact of the webinar on their personal and professional development. As an average, respondents moderately agreed that the webinar impacted their personal and professional development, with 91% slightly, moderately, or strongly agreeing. Additionally, thematic analysis of required written reflections indicated a majority of students (62.5%) identified the need for additional medical humanities education about the Holocaust and its relevance to medicine. Holocaust education encourages medical students to bear witness to past medical atrocities and critically assess the profession and their personal-professional growth. Continued structured integration of the Holocaust in medical education supports critical self-reflection and the development of morally courageous physicians who endorse and practice social accountability in medicine.

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p<0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

Evaluation and analysis of strength values assessed pre and post pitch session in an MLS team during the season and after the off season

Evaluation and analysis of strength values assessed pre and post pitch session in an MLS team during the season and after the off season

Artificial Intelligence-Assisted Speech Therapy for /ɹ/: A Single-Case Experimental Study.

This feasibility trial describes changes in rhotic production in residual speech sound disorder following ten 40-min sessions including artificial intelligence (AI)-assisted motor-based intervention with ChainingAI, a version of Speech Motor Chaining that predicts clinician perceptual judgment using the PERCEPT-R Classifier (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets). The primary purpose is to evaluate /ɹ/ productions directly after practice with ChainingAI versus directly before ChainingAI and to evaluate how the overall AI-assisted treatment package may lead to perceptual improvement in /ɹ/ productions compared to a no-treatment baseline phase. Five participants ages 10;7-19;3 (years;months) who were stimulable for /ɹ/ participated in a multiple (no-treatment)-baseline ABA single-case experiment. Prepractice activities were led by a human clinician, and drill-based motor learning practice was automated by ChainingAI. Study outcomes were derived from masked expert listener perceptual ratings of /ɹ/ from treated and untreated utterances recorded during baseline, treatment, and posttreatment sessions. Listeners perceived significantly more rhoticity in practiced utterances after 30 min of ChainingAI, without a clinician, than directly before ChainingAI. Three of five participants showed significant generalization of /ɹ/ to untreated words during the treatment phase compared to the no-treatment baseline. All five participants demonstrated statistically significant generalization of /ɹ/ to untreated words from pretreatment to posttreatment. PERCEPT-clinician rater agreement (i.e., F1 score) was largely within the range of human-human agreement for four of five participants. Survey data indicated that parents and participants felt hybrid computerized-clinician service delivery could facilitate at-home practice. This study provides evidence of participant improvement for /ɹ/ in untreated words in response to an AI-assisted treatment package. The continued development of AI-assisted treatments may someday mitigate barriers precluding access to sufficiently intense speech therapy for individuals with speech sound disorders. https://doi.org/10.23641/asha.26662807.

Self-Injurios Behaviour in an Adult with Autism Spectrum Desorder

Self-injurious conduct is a highly maladaptive behaviour that is often associated with severe mental retardation and autism. Research has highlighted the complexity and multifactorial nature of the aetiology of the disorder. In this paper we present, after careful analysis, the treatment of an adult subject with autism spectrum disorder to reduce self-injurious behaviour and teach him more effective and less disabling ‘coping strategies’. The experimental design used is of the criterion-variant type. The analysis of the data showed that the goals set were achieved. In the post-treatment sessions, we achieved extinction of the target behaviour.

2263 Learning geriatric syndromes through case-based discussion (CBD)

Abstract Introduction Geriatric syndromes are traditionally taught through didactic teaching and bed side tutorials. However, these do not consider the science of learning and the strategies needed for a novice learner. It is prudent to manage cognitive load, create associations through testing and enforce deliberate practice for a novice as opposed to an advanced learner. Case- Based discussions (CBD) serve as an apt tool to deliver knowledge covering geriatric syndromes; aimed at testing learner’s understanding through its application to a simulated patient profile. This pilot aimed to test the applicability of CBD to teach geriatric syndromes to novice learners. Method A scoping review was completed by medical officers starting on their geriatric medicine rotation in a Singapore tertiary hospital to determine syndromes which they request dedicated teaching for within curriculum. Learners ranked Incontinence and Falls with Osteoporosis management as the top 2 geriatric syndromes of interest. Focus group discussion using Rogers’s theory of diffusion principle was undertaken to understand both the advantages and challenges of CBD. Clinical scenarios were curated specific to the 2 topics with learner’s completing a pre session quiz beforehand to determine their baseline knowledge. The topic specific CBD was done via zoom platform with questions applied in a graded fashion; components include that of diagnosis, evaluation, and management of select syndrome. Learners completed a post session quiz 1 week after the CBD to determine retention of knowledge. Results Quantitative Feedback received from the learners highlighted that more than 90% would want CBD to be implemented for other geriatric syndromes. There was an improvement in the average score obtained in post session quiz for Osteoporosis from 6.09 to 6.75. However, there was notably poor participation in the post session quiz. Conclusion This pilot highlights that CBD should be utilised to enhance teaching of clinical concepts in geriatric medicine.

The effects of N-acetyl cysteine on intrinsic functional connectivity and neural alcohol cue reactivity in treatment-seeking individuals with alcohol use disorder: a preliminary study.

N-acetyl cysteine (NAC) is a potential pharmacotherapy for alcohol use disorder (AUD), but it is not known whether it modulates neural activation to alcohol cues or intrinsic functional connectivity. We investigated whether NAC attenuates (i) alcohol cue-elicited activation, and (ii) intrinsic functional connectivity compared to placebo in patients with AUD. In this preliminary study, twenty-three individuals (7 females) with moderate-severe AUD received daily NAC (2400mg/day, n = 9), or a placebo (n = 14) for at least 2 weeks. Participants completed a pre-treatment functional magnetic resonance imaging session (T0) and a post-treatment session (T1) comprising resting-state and visual alcohol cue reactivity task acquisitions. Activation differences between sessions, treatment, and session-by-treatment interaction were assessed. Resting-state functional connectivity examined using 377 node ROI-to-ROIs evaluated whether NAC reduced intrinsic functional connectivity after treatment. There were no differences in alcohol cue reactivity for brain activation or subjective craving between NAC and placebo during treatment or across sessions, or significant interaction. A significant treatment-by-time interaction, with reduced intrinsic connectivity was observed after treatment (T1) for NAC-treated compared to placebo-treated patients in the posterior cingulate node (9, left hemisphere) of the dorsal attentional network and connections to salience, ventral-attentional, somatosensory, and visual-peripheral networks implicated in AUD. NAC reduced intrinsic functional connectivity in patients with moderate-severe AUD after treatment compared to placebo, but did not attenuate alcohol cue-elicited activation. However, the absence of cue reactivity findings may result from low power, rather than the absence of cue reactivity findings associated with NAC. These results provide preliminary evidence that NAC treatment may modulate intrinsic functional connectivity brain activation in patients with alcohol use disorder, but replication in larger studies are required to determine the strength of this effect and any associations with clinical outcomes. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT03879759.

An evaluation of a simulation-based training programme to support final-year medical students in their preparation for foundation-year prescribing practice

Abstract Introduction Prescribing is a high-risk and error prone activity with doctors reporting a lack of preparedness for prescribing practice,[1] with potential for simulation-based training (SBT) to enhance prescribing skill development.[2] To support preparation for prescribing practice, a team-based SBT programme was developed for final-year medical students. Aim To determine the impact of the SBT on prescribing knowledge and student perceptions of SBT in supporting their prescribing practice. Methods An SBT event was designed to include three complex multi-morbid scenarios reflecting foundation practice. The scenarios were co-produced by a multidisciplinary team, with sessions facilitated by clinical pharmacists. Sessions focused on practical prescribing and authentic decision-making with a convenience sample of final-year medical students. Students worked in small groups to manage conditions including heart failure, atrial fibrillation, diabetic keto-acidosis and chronic obstructive pulmonary disease, all followed by a facilitated debrief. Effectiveness of the SBT on understanding of the treatment of the topics was measured anonymously using ten multiple choice questions (MCQs). A 28-item survey was self-administered to students pre and post session, including demographic questions and prescribing confidence agreement statements using a 5-point Likert-scale (strongly disagreed to strongly agreed), with further open-ended questions used to evaluate views of the SBT, and the perceived impact on prescribing confidence. Data were entered into a database and analysed using SPSS v29. Mann-Whitney U-tests were used to determine differences in unpaired agreement scores with independent t-tests used to explore change in unpaired MCQ test-scores. Results Thirty-seven students attended the SBT with 34 students completing post session surveys. Pre session, mean test scores were 4.5±2.0, and post session, mean test scores were 7.7±1.5, an improvement of 3.2 (CI 2.4 to 4.1) t(69)= 7.5, p<0.0001 (d=1.8 large effect). Self-rated prescribing confidence scores significantly increased post-teaching for ability to identify drug interactions (pre-median: 3 [neutral], post-median: 4 [agreed], p=0.019), monitoring of medications (pre-median: 3, post-median: 4, p<0.001) and ordering of appropriate investigations (pre-median: 3, post-median: 4, p<0.001), with significant differences in mean rank reported for all other self-rated confidence scores, except for completion of drug histories, and accessing of information resources. The majority of participants strongly agreed/agreed that the training was valuable (99.1%), interactive (94.1%), practical and relevant (97.1%), contextualised prescribing (94.1 %), and helped preparation for practice (94.1%). Students also strongly agreed/agreed that they were more confident with their prescribing (82.3%), and that pharmacists were appropriate subject teachers (97.1%). Open-ended responses suggested that students found the session challenging and tiring, but realistic, focusing on common prescribing scenarios they would likely encounter. The debrief and personalised feedback was valued, whilst students reported that more SBT was needed throughout their training for other topics including fluids and insulin prescribing. Conclusion Deficits were identified for self-rated prescribing confidence and knowledge-based competence on final-year medical students. A contextualised prescribing SBT programme is acceptable and valued by final-year medical students to prepare them for practice. Whilst it can improve medical student prescribing knowledge and confidence, impact on prescribing competence is unknown and further work is required to explore this educational modality on prescribing quality.

P032 Designing a workshop for a temporal artery biopsy simulation

Abstract Background/Aims A temporal artery biopsy (TAB) is performed to confirm a diagnosis of giant cell arteritis (GCA) and it is recommended by clinical practice guidelines. Historically there have been limited opportunities to perform this procedure and teaching has been largely informal and non standardised. This impacts a trainee’s confidence and competence and potentially patient safety. Simulation is crucial in modern day surgical education and so we designed, organised and delivered a wetlab to teach the steps of TAB to address these issues. Methods The event took place at the Welsh Institute for Minimal Access Therapy (WIMAT) centre in Cardiff. The WIMAT team developed the TAB models to be used. The event covered all of the theoretical aspects of performing a TAB, a demonstration on how to map the temporal artery, how to perform an ultrasound doppler procedure to locate the temporal artery and finally hands on experience performing a TAB with two different complexity models. Participants were asked to complete a 30 item Google Forms Questionnaire to help us to evaluate pre and post session knowledge, understanding and learning experiences pertaining to TAB. Results Participants noted significant improvements in their knowledge and understanding pertaining to all domains covered. A lack of knowledge, a lack of procedures previously performed, concern about damaging the facial nerve and lack of senior support/supervision were all identified as reasons as to why trainees get apprehensive when it comes to performing a TAB. Conclusion This novel formal teaching event provides a blueprint for deaneries to use in their teaching of TAB’s which can benefit trainees and patients. Modern surgical education benefits from wetlabs with expert supervision. Our findings also emphasise the benefits of cross specialty collaborative work. Disclosure S. Rehan: None. P. Watts: None. I. Williams: None. P. Hennessy: None. C. O’Flaherty: None. A. Haridas: None.

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up.

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

Music Therapy to Facilitate Relationship Completion at the End of Life: A Mixed-Methods Study.

The concept of relationship completion is embodied as the core belief for end-of-life care in Taiwan, known as the Four Expressions in Life. No studies have been published investigating and trying to understand how music therapy facilitates the Four Expressions in Life. This convergent mixed-methods study examined the effects of music therapy to facilitate relationship completion for patients at the end of life and their families in Taiwan, and explored their personal experiences in music therapy sessions. Thirty-four patients at end-of-life care and 36 of their family members participated in a single music therapy session with a one-group pretest-posttest design using standardized quality-of-life measures for patients at the end of life and families. A nested sample of 5 patients and 9 family members completed semi-structured interviews. Significant differences between the pre and post session scores were revealed for patients in the Life Completion subscale of the QUAL-E (p < .001), and the global QoL Indicator (p < .001), and for families in the Completion subscale of the QUAL-E (Fam) (p < .001), and the Overall Quality of Life (p < .001). Four themes around opportunities emerged from the interviews: the opportunity for exploration, for connection, for expression, and for healing. The integrated findings suggest that music therapy facilitated relationship completion and improved quality of life for both patients and their families. Furthermore, this study supports that the transformative level of music therapy practice within a single session for end-of-life care is attainable.

Acute response in circulating microRNAs following a single bout of short-sprint and heavy strength training in well-trained cyclists.

Background: Heavy strength (HS) and short-sprint (SS) are commonly used training methods for competitive road cyclists, with the aim to improve the anaerobic power and short time cycling performance. Knowledge of how such training methods affects biochemical as well as molecular factors, are particularly important for determining individual recovery and long-term adaptations. The primary aim of the current study was to investigate the expression levels of small non-coding RNAs in response to HS and SS training in elite cyclists as potential biomarkers for individual optimal restitution time. Methods: Eleven well trained cyclists performed one session of HS training and one session of SS training on separate days. Blood samples were taken at baseline and 5min, 1h and 21h post training. Along with physiological measurements and biochemical factors (serum creatine kinase, myoglobin, human growth hormone and plasma lactate), real-time quantitative PCR was used to explore whether HS and/or SS training influenced the abundance of 24 circulating miRNAs, in serum, associated with muscle development, angiogenesis, and/or inflammation. Results: Based on complete miRNA profiles from nine cyclists, the miRNAs showing most altered expression after both training sessions included the three striated muscle-specific miRNAs (myomiRs) miR-1-3p, 133a-3p and 133b-3p. While all three miRNAs showed significantly highest expression at 1h post HS session, the acute effect of the SS session included a significantly higher level of miR-1-3p alone, at 5min (highest), as well as at 1h and 21h post session. Correlation (negative) with biochemical markers was only shown for miR-133a-3p and CK (r = -0.786, p = 0.041) and between miR-133b-3p and [La-] (r = -0.711, p = .032), at 21h post SS session. Conclusion: Our findings support that unique myomiRs are regulated by HS and SS training. Such knowledge may be important for individually adjusted restitution times.

A novel physiotherapeutic approach for the treatment of Os Naviculare: A case study.

Background: Os naviculare in general alters the functional and anatomical balances of the longitudinal plantar arch. A substantial number of the posterior tibialis tendon fibers insert on the accessory ossicle instead of its insertion on tarsal and metatarsal bones resulting in unbalanced stress forces on the tendon. The presence of an accessory navicular type II or type III is a risk factor for PTT tendinopathy and possible PTT tear. Methodology: In this single subject case study, the participant reported with the pre-diagnosed Os naviculare. On examination at initial presentation, the navicular tuberosity of the affected foot was prominent as compared to the contralateral limb. The site was tender on palpation. Ankle range of motion was within normal ranges except ankle dorsiflexion was slightly compromised. Mild pain on active and resisted was noted. Functional tests like star excursion balance test, single leg standing could not be performed due to pain. Pre and post protocol assessment was graded and measured on Cumberland ankle instability tool. The tenderness was recorded using numeric pain rating scale. Star excursion balance test was performed one on 8th day and post protocol. MWM was performed at distal tibiofibular joint on 6 days every week for 3 weeks alongside the conventional regime exercises and ultrasound was applied post treatment session. Result: Result of this study suggested that addition of MWM of distal tibiofibular joint in the conservative exercise protocol was effective in the reduction of pain, dysfunction and improved dynamic control. Conclusion: The results of this study suggests that the addition of MWM of distal tibiofibular joint alongside conservative management shows appreciable effect in improving dysfunction, dynamic stability and reducing pain in individual with congenital Os naviculare.

Effectiveness of Chest Physiotherapy in Broncho Pulmonary Clearance in Respiratory Distress Neonates

Purpose: Globally, the mortality rate of respiratory distress has been quite high due to unability to maintain oxygenation and overcome abnormal work of breathing. Chest Physical therapy, apart from providing advantageous outcomes to the adults, chest physical therapy is pivotal for newborns too but differs in terms of physiology and anatomy. Various chest physiotherapy techniques including percussions, vibrations, and compressions are quite effective in reducing mortality rate in neonates.Many studies has been conducted worldwidely, but still there has been limited data in Pakistan about the effect of bronchopulmonary clearance in neonatal intensive care unit, so this study was conducted to find the effectiveness of chest physiotherapy in neonatal intensive care unit&#x0D; Materials and Methods: This was the non-randomized controlled trial study conducted in tertiary care hospital of karachi , Pakistan. Total 40 samples collected through convenient based sampling were included in this study . The inclusion criteria including gestational age more than 37 weeks with atelactasis, mucous plugging, airway compromised, intubated or extubated, hospital admission, and chest complications where as exclusion criteria included cardiopulmonary instability, post surgery, pre term, intra ventricular hemmorage, fits or epilepsy, failure to thrive, and on consistent feed. Bronchopulmonary Clearance techniques such as Percussions , Compressions, and Vibrations along with suctioning and postural drainage were performed routinely twice daily session one in morning and one in evening was performed for total 14 days which means total 28 sessions of chest physiotherapy was implemented and chest xray, sp02, Heart rate, and respiratory rate was measured pre and post the sessions.&#x0D; Findings: The mean age of the participants were 37.050±5.57, out of which 20(52.5%) were females and 19(47.5%) were males. Result showed that post chest xray after chest physiotherapy was .2500±.49355 and post session spo2 was 2. .075 ± 4.56513. The chest physiotherapy was statistically significant in mucociliary clearance, lung expansion, preventing atelectasis, airway clearance, and other chest complications (0.008).&#x0D; Implications to Theory, Practice and Policy: Limitations of this study were that small sample size was taken, and data was collected from one tertiary care hospital of Karachi so it doesn’t showed generalization. Further studies in terms of large sample size are required for validity and reliability of this research.

1826 Development of inter-professional simulation-based education in geriatric medicine

Abstract Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles (1). We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Method We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty. Results Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being “not at all confident” and ten “extremely confident”). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment. Conclusion Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.

Argon plasma coagulation: an effective treatment for solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy. Determine the efficacy of APC treatment for patients suffering from SRUS. Prospective, single center. Gastroenterology department at a military hospital in Pakistan. This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment. Effectiveness of APC for resistant SRUS. 99 patients. The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications. APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients. Single centered.

Extent of Achieving KDOQI Targets For hemodialysis Adequacy in Libyan dialysis patients: A Multicentre Cross-Sectional Study

Dialysis is a therapy to maintain the lives of end stage renal disease patients (ESRD), and the adequacy of hemodialysis is essential as it can improve patient’s survival, quality of life and biochemical profiles. This study aimed to evaluate the extent of achieving Kidney Disease Outcomes Quality Initiative (KDOQI) targets for dialysis adequacy, haemoglobin level, mineral bone disorders and nutritional status among hemodialysis patients. patients and method: This study was carried out on 286 regular haemodialysis adult patients from eleven hemodialysis centers in Libya. Patients subjected to BMI calculations. Blood samples collected for complete blood count, serum albumin, blood urea pre and post dialysis session, serum creatinine, total serum calcium, serum phosphate, serum alkaline phosphatase, C reactive protein, and serum iPTH levels. Targets measures based on the KDOQI Clinical Practice Guidelines. Result: Mean Kt/V was 1.31±0.40.only 174 (60.84%) patients had adequate dialysis dose (Kt/V&gt;1.2). Mean iPTH was 490.08±694.7. According to the KDOQI, guideline 19.2% of the patients was within the target range for parathormone level. 26.92 % of studied patients had a haemoglobin level of 11gm/dl or more. Mean serum albumin is 3.81±0.64, hypoalbuminemia (albumin &lt;3.5g/dl) was in 27.98% of studied patients. Conclusion: According to KDOQI guidelines 39.16% of the studied patients did not achieve the target dose for adequate clearance, 73.08% did not achieve the target haemoglobin level; and, only 19.2% of the studied patients were within the target range for parathyroid hormone level. According to BMI as nutritional markers, 14.0% of studied patients were underweight and 27.98% were with serum albumin below (3.5 g/dl).

Exploring UK undergraduate healthcare students’ perspectives on how to effectively design IPE: A qualitative study

ObjectivesTo explore healthcare undergraduates' views on how to design effective IPE. The need for interprofessional education implementation in undergraduate healthcare education is gaining wide recognition globally. Students' views about their learning experiences can offer useful insights to advance teaching and learning courses. Thus, in the IPE literature, students’ views on how to effectively design IPE can help shape future IPE plans. MethodsPurposeful sampling was used to recruit healthcare students who attended IPE events across three UK institutions. Virtual focus groups were conducted, and audio recorded. Transcripts were thematically analysed and relevant themes were presented under three subheadings, pre, during and post IPE session. ResultsTwenty-five students from medicine, nursing, pharmacy, midwifery and other disciplines participated in six focus groups. Students thought IPE should be offered consistently across the programme's years of study to ensure learning continuity. Students from programmes with higher placement hours (nursing and midwifery), suggested more IPE in placement. Pre-IPE sessions, introducing IPE to students attending for the first time was perceived to be important as the lack of awareness/understanding of IPE could adversely impact their willingness to attend and their engagement. During IPE, interaction with other students was perceived as the core of an effective IPE session. Students reported difficulties in communication with other students via online IPE sessions and thought they were less engaged compared to face-to-face sessions. Post-IPE, students valued reflective exercises, whereas traditional formal assessment was seen as a barrier to engagement with the learning. ConclusionStudents considered IPE valuable to prepare for future practice. However, students felt that IPE experiences could be enhanced with proper planning to ensure regular compulsory IPE exposure. For better IPE experiences, IPE design and delivery should be in line with each healthcare programme's unique learning and training curriculum.

Cognitive behavioral therapy for insomnia in a military traumatic brain injury clinic: a quality improvement project assessing the integration of a smartphone application with behavioral treatment

ObjectivesWhile the association between insomnia and traumatic brain injury (TBI) is well established, TBI rehabilitation programs that focus on sleep as a primary target are limited. Cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for insomnia, however; its use within TBI clinics is relatively unknown. Therefore, our aim was to evaluate the implementation of CBTi, used in conjunction with a smartphone app for insomnia, within a US military TBI program to improve care within this setting.SettingA TBI clinic at a US military installation.MethodsMHS beneficiaries underwent 6 sessions of CBTi and a 1-month post-treatment follow up session. Data was collected at each treatment session as part of routine clinical care.ResultsA total of 69 US MHS beneficiaries seen at a TBI clinic with a diagnosis of insomnia began CBTi. Attrition rate at the end of the CBTi program and 1-month posttreatment session was 35% and 48%, respectively. Results demonstrated that sleep onset latency (SOL) and wake after sleep onset (WASO) decreased during treatment (p's &amp;lt; 0.001). Further, symptoms reported on the Insomnia Severity Index (ISI) improved during CBTi (p &amp;lt; 0.001).ConclusionFindings demonstrate how CBTi used in conjunction with a CBTi smartphone application can be used to effectively treat insomnia for MHS beneficiaries seeking care for TBIs. This evaluation provides the basis for further research on how CBTi may improve care within TBI programs.