Hours Of Preparation Research Articles

Creation of an Automated and Comprehensive Resident Progress System for Residents and to Save Hours of Faculty Time: Mixed Methods Study.

It is vital for residents to have a longitudinal view of their educational progression, and it is crucial for the medical education team to have a clear way to track resident progress over time. Current tools for aggregating resident data are difficult to use and do not provide a comprehensive way to evaluate and display resident educational advancement. This study aims to describe the creation and assessment of a system designed to improve the longitudinal presentation, quality, and synthesis of educational progress for trainees. We created a new system for residency progress management with 3 goals in mind, that are (1) a long-term and centralized location for residency education data, (2) a clear and intuitive interface that is easy to access for both the residents and faculty involved in medical education, and (3) automated data input, transformation, and analysis. We present evaluations regarding whether residents find the system useful, and whether faculty like the system and perceive that it helps them save time with administrative duties. The system was created using a suite of Google Workspace tools including Forms, Sheets, Gmail, and a collection of Apps Scripts triggered at various times and events. To assess whether the system had an effect on the residents, we surveyed and asked them to self-report on how often they accessed the system and interviewed them as to whether they found it useful. To understand what the faculty thought of the system, we conducted a 14-person focus group and asked the faculty to self-report their time spent preparing for residency progress meetings before and after the system debut. The system went live in February 2022 as a quality improvement project, evolving through multiple iterations of feedback. The authors found that the system was accessed differently by different postgraduate years (PGY), with the most usage reported in the PGY1 class (weekly), and the least amount of usage in the PGY3 class (once or twice). However, all of the residents reported finding the system useful, specifically for aggregating all of their evaluations in the same place. Faculty members felt that the system enabled a more high-quality biannual clinical competency committee meeting and they reported a combined time savings of 8 hours in preparation for each clinical competency committee as a result of reviewing resident data through the system. Our study reports on the creation of an automated, instantaneous, and comprehensive resident progress management system. The system has been shown to be well-liked by both residents and faculty. Younger PGY classes reported more frequent system usage than older PGY classes. Faculty reported that it helped facilitate more meaningful discussion of training progression and reduced the administrative burden by 8 hours per biannual session.

WP6.10 - Factors Impacting Success in The Intercollegiate Membership of The Royal College of Surgeons Examinations

Abstract Aims We have witnessed within surgical training schools, that the attainment of the Intercollegiate Membership of the Royal College of Surgeons iMRCS examinations Part A and Part B continues to be one of the greatest challenges within core surgical training. This study aims to explore a trainee’s examination experience and factors influencing success and examination challenges. Methods A voluntary electronic survey including demographic factors, preparation specific approaches and adjuncts, challenges and barriers was sent to Northern Ireland core surgical trainees. Results were correlated with their examination outcomes. The results were collated using Microsoft excel software. Statistical analysis was completed using SPSS and thematic analysis of free text responses carried out. Results Twenty-seven trainees responded to the survey. The modal age category was 25-34 years with a male to female preponderance of 16 males to 11 females. English language was the first language of 60% of respondents. Statistical significance was demonstrated between age and first-time pass rate in the Part B. No statistical significance was demonstrated between first time pass rate and gender, English language, or background. Forty eight percent of those surveyed attributed personal attitude as a major contributor to success. Conclusion Those who undertook Part A closer to foundation training appeared to require fewer attempts to be successful in Part A, and the hours of preparation and study undertaken, correlated to feeling of preparedness. Part B success correlated to clinical experience.

Optimization of parameters affecting the recovery in the analysis of polycyclic aromatic hydrocarbons in natural waters by HPLC-fluorescence

To improve the recovery percentages in the analysis of PAH (polycyclic aromatic hydrocarbons) in natural waters, parameters such as standard stability, filtration, storage time and matrix effect were optimized for five PAH by HPLC-FD. For aqueous standards, with the addition of 10% acetonitrile, good linearity was found for naphthalene, acenaphthene, anthracene, pyrene, and chrysene curves up to the second day of standards preparation. In filtration, the best results were obtained using the AP10 and Nylon filters with 10% acetonitrile, with recovery ranges of 98-72% and 93-56%, respectively. In contrast, lower values were obtained with cellulose filters in a polyethylene holder without the addition of 10% acetonitrile with recoveries of 52-0%. A 23 factorial design established, for natural water, that the most important factors were: storage time for naphthalene and acenaphthene, with area losses at 48 hours and the use of organic solvent for anthracene, pyrene and chrysene, with area gain for 20 % acetonitrile. For liquid-liquid extraction in standards, recoveries of 62-45% were found in aqueous matrix without acetonitrile and 98-35% with 20% acetonitrile + 2.5% NaCl, at 24 hours of preparation.

Evaluation of Preparation and Outcome of the Joint Admissions and Matriculation Board Examinations Among First Year Medical Students in Rivers State

Background: In most countries of the world, entrance into tertiary institution is regulated by statutory examining councils / bodies, after passing recommended examinations. The aim of this study was to evaluate the determinants of success at the Nigerian University Tertiary Matriculation Examination (UTME) among first year undergraduate medical students in Rivers State in the year 2022. Materials and Methods: A retrospective cross-sectional analytical study was carried out among first year undergraduate medical students in four universities. Data was collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: There were 219 (45.1%) males and 267 (54.9%) females, and their mean age was 19.45±2.80 years. Majority (n=372, 76.6%) of students prepared daily for at least 3-4 hours over at least 3 to 4 months (n=179, 36.8%) before passing their examinations. There were computer-related (134, 27.6%) and other issues. Only 257 (52.9%) students passed their UTME at first attempt. The number of UTME attempts reduces as average daily preparation hours increases; the higher the average daily examination preparation hours, the higher the chances of scoring above 200 in first attempt; the higher the number of months of active preparation, the lower the number of attempts at UTME; and these relationships were statistically significant (being p=0.000, p=0.009, and p=0.036 respectively). Conclusion: The determinants of success at the UTME of the JAMB among others are associated with students’ quality of input in preparing for the examinations. There are roles to be played at multiple levels to achieve needed improvement.

“FLIPPED ASSESSMENT”: Proposal for a Self-Assessment Method to Improve Learning in the Field of Manufacturing Technologies

Striving toward goal completion and achieving objectives is one of the motors of personal advancement. The path to goal completion is fueled by many reasons, among which motivation stands out as one of the core impulses. Motivation acquires a particularly high relevance in learning, prompting educators to mind its substance when designing not only the material to be imparted but also the approach and the mechanisms to assess knowledge acquisition. The intrinsic nature of motivation might stem from self-realization, thriving in specific goals, or even exploring unknown ground. One of the main teacher–student interactions is the provision of adequate tools to achieve learning outcomes. One of the tools available to teachers is the exercise of extrinsic motivation. This paper proposes and assesses the initial implementation of a student-involved extrinsic motivation method. A pilot group in the Junior year of a Bachelor in Mechanical Engineering program was selected, in which the evaluation system was slightly modified with respect to the system that is normally used. The course selected for the study was a compulsory six European Credit Transfer and Accumulation System (ECTS) course covering production and manufacturing technology. Students were asked to partake in the drafting of questions to assess their own knowledge, hence indirectly increasing their motivation to learn the content. The tentative results obtained with the pilot group appear to be positive and relevant. Students showed a higher engagement during class and reported needing fewer hours of preparation at home (32% reduction). In addition, global satisfaction with the course was improved.

Fellow-led didactics in a hematology/oncology fellowship program.

11026 Background: The pandemic in 2020 made us used to virtual learning, but as we recover from the pandemic, we are forced to rethink how we deliver education to trainees in medicine. The pandemic has led to a significantly decreased attention span and face to face interactions, in addition to an increased screen time. In our program, this led to us noting a lower engagement in the fellowship didactics as we recovered from the pandemic. This forced us to rethink how the Oregon Health & Science University (OHSU) hematology and oncology fellowship delivers educational content. After interviewing all stakeholders, we moved to an in-person fellow led didactic approach, under the mentorship of a faculty expert who helps trainees design content and is present for discussion. The rationale behind this approach was to boost peer-to-peer learning, supply relevant content and increase engagement. The fellows and faculty were provided guidelines about length of talk, presentation of data and use of interactive tools. Methods: After 6 months of introducing fellow led didactics, we surveyed all fellows and select faculty who were mentors on more than one occasion about their opinion. A survey link was sent to all 12 fellows and 18 faculty members who regularly took part in fellowship didactics. Results: All 12 fellows responded to the survey. On a Likert scale of 1-5, they scored improvement in knowledge at 4.58 (0.64) and rated both the content and presenter at 4.25 (0.43). A third felt that this way of delivering didactics was a lot better and the rest felt it was a little better. On the negative side, they felt that they were spending more time preparing content (40% spent 7-9 hours a month) but were optimistic about lesser commitment next year as we bank the PowerPoint presentations. Nine of the 18 (50%) invited faculty responded to the survey, and on a scale of 1-5, they rated their improvement of knowledge as 4.44 (0.68). They scored the content and presenter at 4.44 (0.5) and 4.56 (0.68) respectively. 88.9% felt that the didactics were either a little or a lot better, and 11.1% felt them to be the same. On average, they spent less time on the content than they did if they were presenting. Conclusions: Overall, both faculty and fellows felt that this method of delivering didactics in a hematology oncology fellowship program was more effective. The fellows felt that they needed to put in extra hours for preparation, but this will probably go down as they build on earlier presentations.

Gender Gap in Access to the Driving Licence: Experimental Evidence from France

ABSTRACT In this article, we assess the gender difference in response from driving schools to a request for information about the requirements to pass the driving licence. To this purpose, we created fictitious profiles for two young candidates seeking a driving licence training, a woman and a man, who were similar in all other aspects. We conducted two waves of experiment on 290 driving schools randomly selected from an exhaustive list of French driving schools. The feedback received from driving schools that responded to both candidates is examined to investigate differences in treatment between the male and female applicants. Our analysis shows that driving schools propose a slightly significantly higher maximum number of hours of preparation for the road test when the candidate is a woman: on average, driving schools propose 1.5 more hours of training to women than to men. On the other hand, we do not find a significant gender difference in the price of the training offered and few differences in other variables related to the content of the response.

Burglar for Peace: Lessons Learned in the Catholic Left's Resistance to the Vietnam War by Ted Glick

Reviewed by: Burglar for Peace: Lessons Learned in the Catholic Left's Resistance to the Vietnam War by Ted Glick Eric Martin Burglar for Peace: Lessons Learned in the Catholic Left's Resistance to the Vietnam War. By Ted Glick. Oakland, CA: PM Press, 2020. 203 pp. $20.00. "I believe that we can change the world. I really do." These words close the stirring personal testimony and valuable historical documentation of the Catholic Left in Ted Glick's Burglar for Peace. Told with first-hand stories, journals, old letters, and court transcripts of many who made up the draft board raid movement to stop the Vietnam War in the late 1960s and early 1970s, Glick's book acts as a memoir of a period in his life as well as a snapshot of the American Catholic underground's most visible offensive against the war. Compelled to action in the wake of Martin Luther King Jr.'s assassination, Glick threw himself into the campaign of Bobby Kennedy before turning to what became known as "the ultra resistance." His first action came in 1970 with the East Coast Conspiracy to Save Lives group of eleven, including two nuns and four priests, who destroyed thousands of draft files. He provides details that are rarely noted about these [End Page 65] actions, such as how they broke in (planting someone at the top of the stairs during the day who would open a door after closing) or cased the buildings (having fake couples in a parked car observe late-night light patterns in the building for weeks ahead of the action). This allows for the movement's dramatic lore of theft, liturgical pyres, and prison witnesses to be complemented with the tedium of long hours in preparation, captured in poems Glick wrote while hiding in the building. "The sun is coming down slowly, casting window frame shadows upon the wall a half flight down. We wait for the time" (33). Accounts like these let us see more clearly the ingredients that made up the splashy morning headlines. Among recent releases on major figures in the movement like John Loughery and Blythe Randolph's Dorothy Day, Bill Wylie-Kellermann's Celebrant's Flame (on Dan Berrigan), and William Marling's Christian Anarchist (on Ammon Hennacy), Glick's book is a refreshing view from one of the many lesser-known voices in the Catholic Left. One of its significant contributions is providing detailed court transcriptions not just of those in the movement but also of their interrogations of the FBI on the stand, giving space to the words of unfamiliar names along with the attention given to Liz McAlister and the Berrigans. Teachers looking for concrete descriptions of what resistance in the Catholic Left entailed will find Glick's treatment of lengthy prison fasts and solitary confinement to be valuable resources for undergraduate students, laid out in straightforward journal form. For those looking beyond the canon for treatments of the Catholic Left (from someone who was not Catholic and details reasons for leaving the movement), nonviolence in the American anti-war movement, or a convicting call to action in our present from a veteran in peaceful rebellion, Burglar for Peace is, to borrow from Glick's opening words in the preface, a way to "find oneself going deeper and deeper" (xiii). Eric Martin University of California, Los Angeles Copyright © 2022 American Catholic Historical Society

Rapid Donor-Specific Single Nucleotide Variation Detection by Nanopore Sequencing of Ex Vivo Lung Perfusate

<h3>Purpose</h3> Donor-derived cell-free DNA (cfDNA) has been shown to be useful to monitor the health of the lung graft. To distinguish donor from recipient cfDNA in the blood, single nucleotide variations (SNV) between the genome of the donor and recipient are generally used. However, this requires whole genome sequencing which is time-consuming and costly. A recently developed sequencing technology known as nanopore sequencing may prove to be a solution. Nanopore sequencing requires minimal preparation and sequences are read out in real-time. When combined with ex vivo lung perfusion (EVLP), we hypothesize that we can rapidly generate a donor-specific SNV map by nanopore sequencing of the perfusate cfDNA. In this study, we investigated the feasibility of using the nanopore sequencer to call donor SNVs from EVLP perfusate cfDNA (<b>Fig A</b>). <h3>Methods</h3> EVLP perfusate samples from 4 clinical cases were collected at 4h of perfusion. DNA was extracted and library preparation performed using the Oxford Nanopore Rapid Sequencing Kit (<b>Fig B</b>). To correct for the low accuracy of nanopore sequencing, identified SNVs were compared to publicly accessible databases of common SNVs (dbSNP) in the population. We further compared the SNVs identified by nanopore sequencing with short-read sequencing of the same sample in 1 case. <h3>Results</h3> The mean and range of reads generated in the four cases were 69k and 6k-247k respectively. The average dbSNP overlap was 16,116, with a range of 907-57,558 (<b>Fig C</b>). In the case where we compared to short-read sequencing, we obtained 13,976 SNV overlaps. All sequencing was possible within 4 hours of preparation from perfusate samples. <h3>Conclusion</h3> The nanopore sequencer allowed us to quickly search for donor SNVs from cfDNA in EVLP perfusate. In addition, comparison with short-read sequencing data demonstrated overlap and supports this approach. Further optimization of library preparation and validation with short-read sequencing is needed.

Covid-19 and analysis of needs of the primary school teachers in online-schooling in Iran

This study is a basic qualitative research design in which 48 primary school teachers voluntarily attended a guided focus-group interview in Google Meet platform in April 2021. To design an effective focus group 4 interviews were made with 12 teachers in each. The whole interviews were audio recorded, transcribed, and coded based on the needs and issues mentioned by the teachers. Five problems were highlighted: 1) unfit teaching materials for online schooling, 2) communication issues with their students from the distance, 3) the need for teacher training courses on various aspects of online assessment methods, 4) the need for teacher training courses on various teaching methods in the e-learning platforms, and 5) long hours of preparation for their online classes. The results point the need of preparation of prospective and practice for teachers on online schooling system, abording various aspects of e-learning instructional strategies, classroom management, and assessment methods.

PNS17 Value of a Comprehensive Ophthalmology Custom Pack in a Canadian Setting

To estimate the economic impact of custom surgical packs, sets of disposables and sterile supplies optimally arranged and customized for each surgeon, on cataract and vitreoretinal (vit-ret) surgeries across accounting, materials management, and operating room (OR) departments at hospital and aggregate group levels in Canada. A self-reported time and motion study was conducted in the USA in 2019 among surgical technicians and supply chain managers. Current surgery preparation and materials management practices data were collected via an online survey by surgical technicians (27 cataract/26 vit-ret) and supply chain managers (19 cataract/15 vit-ret). Technicians timed 140 cataract and 140 vit-ret surgeries, recording surgical supply use from a comprehensive pack (Alcon’s Custom Pak®) and other sources. Using these inputs and Canadian facility and labor parameters, a budget impact model (BIM) was developed to estimate time and labor costs across three departments. Assuming 100% use of “generic commodity packs” (no equipment-specific supplies), we explored the impact of transitioning to 100% use of a “comprehensive pack” (Custom Pak®) in one vit-ret and two cataract scenarios. Switching from generic commodity pack use to 100% comprehensive pack use in 1,000 community hospital vit-ret cases saves 27 materials management labor hours and 11 surgery preparation hours annually, translating to 13 additional procedures or CAD$23,853 – primarily OR costs. Implementing this change in 2,500 community hospital cataract cases saves 186 materials management hours and 78 preparation hours annually, or 196 equivalent procedures totaling CAD$53,819. Transitioning from generic commodity pack use to exclusive comprehensive pack use in 50,000 cataract cases at the aggregate group level saves 3,588 materials management hours and 1,550 OR labor hours yearly, gaining 3,916 procedures and saving CAD$1,070,609. Comprehensive surgical pack use improves cataract and vit-ret surgery efficiency, saving substantial operating room and materials management time and cost in Canadian hospitals.

Does Feeding Previously Frozen (Thawed) Fortified Human Milk Increase the Incidence of Lactobezoar (Milk Curd) Obstruction? A Retrospective Cohort Study in One Large Neonatal Intensive Care Unit

BackgroundCurrent recommendations suggest that it is appropriate to store human milk (HM) for up to 24 hours following fortification despite any changes that may occur in fortified HM over time. However, a recent publication suggested fortified frozen HM should be thawed and fed within 12 hours of fortification due to the risk of lactobezoar or milk curd obstruction. ObjectiveThis study investigated whether lactobezoar (milk curd) formation increased when frozen fortified HM was thawed and fed within 12 hours vs 12 to 24 hours postfortification in the neonatal intensive care unit (NICU) at Children’s Hospital of Orange County to determine if practice changes were warranted. DesignThis study was a retrospective cohort study. Participants/settingAll infants admitted to the Children’s Hospital of Orange County NICU for calendar years 2018-2019 who were fed fortified human milk (n = 802) were included in the study. Exposure variableFeedings using previously frozen (thawed) fortified HM. Main outcome measureLactobezoar or milk curd formation. Statistical analysisDescriptive analyses were used for statistical analysis. ResultsOf the 107,602 feedings prepared with fortified thawed HM, 68% (72,602) were used within 12 hours of preparation and 32% (34,499) were stored for 12 to 24 hours before administration. The NICU at Children’s Hospital of Orange County did not identify any lactobezoar formation or milk curd obstruction in either group. ConclusionsData from this study support recommendations for a maximum storage time for thawed, fortified HM of 24 hours.

Continuous and automated slug flow nanoextraction for rapid partition coefficient measurement.

Octanol-water partition coefficients (log Kow) are widely used in pharmaceutical and environmental chemistry to assess the lipophilicity of compounds. Traditionally log Kow is determined using a shake-flask method that uses milliliters of sample and solvent and requires hours for preparation, extraction, and analysis. Here, we report an automated system for rapid log Kow determination for an array of compounds using slug flow nanoextraction (SFNE) enabled by a microfluidic chip. In the method, an autosampler is used to introduce 1 μL of sample into a microfluidic device that segments the injected volume into a series of 4 nL slugs that are each paired to an adjacent octanol slug. Each octanol-water phase pair is compartmentalized by an immiscible fluorous carrier fluid. During flow, rapid extraction occurs at each octanol-water interface. The resulting linear array of slugs flows into an online UV absorbance detector that is used to determine concentrations in the phases, allowing the log Kow to be measured. The microfluidic device allows toggling between two-phase "aqueous plug" generation (aqueous sample separated by fluorous carrier fluid) and three-phase "phase pair" generation. In this way, online calibration for detection in the aqueous phase can be achieved. The method is applied to determining log Kow for a panel of seven pharmaceutical compounds, including complete calibration curves, at three different pHs in under 2 h using 5 μL of extraction standard and 2.9 μL of octanol per extraction standard analyzed.

Post-mortem peripheral smear: A forensic diagnostic tool?

The current study of post-mortem peripheral smears was conducted in Department of Forensic Medicine, Osmania Medical College with the main objective of studying the seasonal variability of autolysis of cell lines in peripheral circulation. In the study sample of 73 subjects, peripheral smears were made in the morgue immediately after collecting blood by venepuncture. Smears were stained with Leishman stain (A Romanowsky stain) within 2 hours of preparation and light microscope was used to study changes. The changes in cell morphology, membrane integrity, cytoplasmic and nuclear changes were studied in detail using valuable information from previous studies and conclusions were arrived at. At the outset white blood cells are most suitable for TSD predictability among others in peripheral smear because they withstand extraneous variables like refrigeration and show a similar degree of autolytic changes across all seasons. The validity of all such studies on cell lines for TSD was discussed from medico legal perspective. The take home message is all the microscopic changes studied in present study provided no added advantage significantly apart from traditional gross changes like rigor mortis, algor mortis, post-mortem lividity. If properly used on regular basis, algor mortis can enhance the quality of our reporting in India with respect to TSD.

Suitability of Roselle-Hibiscus sabdariffa L. as Raw Material for Soft Drink Production

Consumption of conventional soft drinks has been linked with several diseases in man. This has called for the consumption of natural soft drinks such as roselle drink. Roselle-Hibiscus sabdariffa L. is the major raw material for the production of beverage called cranberry (Florida), bissap (Egypt), zobo (Nigeria), and roselle drink generally. The nutritional and phytochemical properties found in roselle make the plant useful in the preparation of some drugs and food. It has been reported that consumption of roselle drink helps to cure diseases such as high blood pressure and diabetes. The pharmacological properties of the plant are traceable to activities of flavonoid and anthocyanin which are the major antioxidants in roselle. Good aroma and colour of the drink are among the characteristics displayed by the plant. However, consumers are sometimes exposed to risks when the drink is consumed after 24 hours of preparation due to the proliferation of spoilage microorganisms in the drink. Most of these microbes thrive even at extreme temperatures. Unfortunately, some of these microorganisms are of public health importance causing diseases such as meningitis and dysentery. Researchers have revealed that roselle calyx is the major source of contamination in the drink. This paper reviews the suitability of the plant for soft drink production. It further highlights the nutrition, pharmacology, and limitations of the plant for soft drink production.

Platelet Count Increment after Transfusion of Fresh and Stored Platelet Concentrates in Children with Acute Lymphoblastic Leukaemia

Background: Therapeutic platelet transfusion is necessary to prevent bleeding due to thrombocytopenia in childhood acute lymphoblastic leukaemia (ALL). Platelet concentrates may be transfused as fresh platelet concentrate immediately or with five days of storage after collection Objectives: To compare the platelet count increment between fresh and stored platelet concentrate transfusion in children with acute lymphoblastic leukaemia. Methodology: This observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, in collaboration with the Department of Transfusion Medicine and Paediatric Haemato-Oncology, BSMMU, Dhaka. Seventy-two children diagnosed as acute lymphoblastic leukaemia were included in this study. ABO identical whole-blood derived platelet-rich-plasma platelet concentrates (PRP-PCs) were transfused within 24 hours of preparation or 1-5 days of storage. Effectiveness of platelet transfusion was carried out by measuring platelet count prior to transfusion, subsequently 1 hour and 24 hours of transfusion. Result: Post transfusion platelet count at 1 hour and 24 hours with fresh platelet concentrates (FPC) and stored platelet concentrates (SPC) were not statistically significant. Post transfusion platelet increment at 1 hour and 24 hours were also similar in both FPC and SPC. Corrected count increment (CCI) at 1 hour in FPC and SPC were 20.5±10.1 and 18.6 ±6.5 respectively and was statistically not significant (P: 0.168). CCI at 24 hours were 15.5±9.1 and 13±5.8 which were also statistically not significant. Percentage platelet recovery at 1 hour and 24 hours in both FPC and SPC were statistically not significant. But these values in SPC were consistently lower than that of FPC. All the values of FPC and SPC were well apart from the lower limit of CCI and percentage platelet recovery (PPR). It was also observed that 85.1% satisfactory platelet transfusion was achieved with FPC and rest of 14.9% was platelet refractory cases. In 79.5% cases satisfactory platelet transfusion were achieved with SPC and refractory cases were 20.5 %. Conclusion: One to five day’s stored PRP-PCs are as effective as fresh PRP-PCs to achieve satisfactory platelet increment.

Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study.

Few stroke survivors receive upper limb constraint-induced movement therapy (CIMT). The aims of this study were to evaluate whether a behaviour change program for occupational therapists increased the number of stroke survivors receiving CIMT, describe the time and process involved in delivering the first program, any adverse events, fidelity and dose of CIMT provided, and upper limb outcomes. A feasibility pre-post implementation study design was used, with intervention and measures for therapists and stroke survivors. Intervention for occupational therapists was informed by the Behaviour Change Wheel and included CIMT training, barrier identification, mentoring and a community of practice. Therapists delivered 2-week CIMT programs with 1:1 supervision, first assisting stroke survivors to identify upper limb goals using the Canadian Occupational Performance Measure. The primary outcome was change in the number of stroke survivors receiving CIMT (program reach). Hours associated with program delivery, adverse events and participant repetitions were recorded (program fidelity and dose). Change in motor function was measured (fidelity) using the Motor Assessment Scale (Upper Limb), Box and Block Test, Nine Hole Peg Test and Motor Activity Log at baseline, program completion (2weeks), 1 and 12months. Program reach: Sixteen stroke participants were recruited (mean 15.3months post-stroke, SD 11.9) and six CIMT programs conducted over 24months, compared to none pre-implementation. The first CIMT program required a mean of 242hours for preparation and delivery. All programs were student-assisted. Fidelity and dose: Stroke participants completed a mean of 360.6 repetitions/hour (SD183.7), and 12,719.6 repetitions/program (SD 6,872.8). Statistically significant changes in upper limb motor function were recorded; some changes were clinically important. The behaviour change program resulted in multiple CIMT programs being delivered safely and with fidelity. Capacity building and skill development took many hours, as did preparation for the first CIMT program.

A Lesson in Failure: When Innovation in Post-Intensive Care Unit Management Yields Negative Results.

Much research has been done in the past few years on post–intensive care syndrome (PICS) and its impact on survivors of the intensive care unit (ICU). This syndrome affects not only patients but their caregivers as well, and it leads to symptoms of anxiety, depression, and post-traumatic stress disorder. Because this is a relatively new area of research, interventions to help address PICS are limited, and those that have been implemented are not yet well studied. Peer support groups have been proposed as a potential intervention to help mitigate the effects of PICS for patients and their caregivers.1 The problem with a peer support group, however, is that people must come to it for it to be effective.With the support of other nurse practitioners within my group as well as representatives from social work and pastoral care, we aimed to start a peer support group for ICU survivors and their families within our institution. After innumerable hours of preparation that included a review of the literature, submission to our institution’s internal review board, development of a marketing campaign, and training of the facilitators, we felt ready to implement our project.We held our first meeting—and no one came. We made several changes to our marketing strategy. After these changes, at our second meeting, 1 person came. We were excited by the positive feedback that we received from the participants that came to the first several groups; however, with an average of about 1 person per meeting, could these meetings really be considered “peer” support groups? Each week we tried something a little different with our marketing strategy: a new sign here, a new announcement there. When flyers and information about the support group were distributed, many families expressed an interest in attending the group, and yet no one came. When we offered drinks and snacks in the waiting areas, most people readily partook; when our marketing highlighted the availability of free drinks and snacks at the peer support groups, still no one came. Even when bedside nurse buy-in was obtained, attendance did not improve. Each week left us more frustrated and disheartened.After a year of bimonthly meetings with only about a dozen total participants, it was hard not to feel like our efforts in health care innovation had failed. As the acceptance letter from the institutional review board sat in our inbox, we were left wondering how many years it would take to collect data to reach what seemed to be an impossible “n.” Perhaps we should leave this kind of thing to the experts from now on? Perhaps. But perhaps there are lessons to be learned from this failure.So, what was the real issue here? Is it that patients and families of the ICU do not need support? We know this is not the case.2 Is it that perhaps a peer support group is not the ideal method for caregivers in the throes of critical illness recovery? One possible reason for our failure is that families do not want to leave the bedside when their loved one’s situation is critical. Another possible reason that our peer support group did not have more participants is that families might not perceive benefit from a peer support group. Recently, peer support group initiatives have been evaluated, and recruitment to groups has been a limiting factor at other sites as well.3 By performing a baseline survey of current and former patients and families of the ICU in our local setting, we may have discovered the true needs of those we were trying to serve.Although a peer support group may work for certain populations, it may not have been the right approach for our clinical setting. Baumann4 cautions that we “need to recognize that the generalizations of evidence-based practice findings must always be checked by listening to and respecting the views and choices of each individual.” We all want to be successful, but the bottom line is that testing and implementing new interventions to improve patient outcomes is challenging, and failure is quite common. Although positive results are generally seen as more favorable, negative findings can “force us to critically evaluate and validate our current thinking.”5 If nothing else, our hope is that by presenting our “failure” at establishing a peer support group in our setting, we can encourage others to perhaps alter their own approaches for improving post-ICU care at their own institution.

Whole-Body Cryotherapy: Potential to Enhance Athlete Preparation for Competition?

The final hours of preparation before competition are important for performance. Recovery, preparation and warm up protocols are evolving continuously and include passive and active modalities often developed by “trial and error” approaches. Passive modalities, such as whole-body cryotherapy (WBC), have the potential to enhance both recovery and preparation. Whole-body cryotherapy has generally been used within a recovery setting after competition or strenuous training for athletes, and in clinical settings for the general population. However, the acute hormonal, anti-inflammatory, perceptual and psychological responses yielded by a single, or repeated, bouts of WBC indicate that this practice could enhance an athlete’s competition readiness when used alongside traditional elements of active warm-ups in the hours before competition in addition to aiding recovery in the hours after. Here we summarize and evaluate the acute effects of WBC exposures on physiological, performance and perceptual responses, and examine the likelihood these responses could theoretically translate into enhanced athletic performance. The potential to enhance an athlete’s performance using acute passive WBC exposure is a novel intervention that requires further investigation.

A pilot study of team-based learning in one-hour pediatrics residency conferences

BackgroundActive learning has been shown to improve knowledge retention, facilitate feedback, and motivate learners. Despite this evidence, lecture, a passive mode of instruction, is the most widely utilized instructional method for residency educational conferences. Team-based learning fosters active learning but is infrequently used during residency training.MethodsThree team-based learning sessions (one introductory and two content-based) were held during noon conferences in a pediatrics residency program. A pre-post static-group design was used to evaluate learner satisfaction and knowledge gains. Additional data was collected about facilitator preparation, session attendance, and readiness assurance test scores. Descriptive statistics and qualitative content analyses were conducted.ResultsForty-seven residents and students participated (81%, 47 of 58). Prior to the introductory session, the majority of participants (55%) were not familiar with team-based learning. After the three sessions, 65% of residents and students reported high levels of satisfaction with team-based learning. When compared to traditional, lecture-based noon conferences, 76% of participants reported more engagement and 48% perceived more learning in team-based learning sessions. Challenges included low completion rates of the assigned reading prior to the session and abridged discussions due to time limitations during sessions. Each session required 10 hours of preparation for curriculum development.ConclusionsTeam-based learning resulted in greater satisfaction and engagement among learners when compared to lecture-based formats. However, it did not prove to be a feasible instructional method during one-hour residency conferences. Adaptations that promote learner preparation for sessions and overcome time limitations during sessions may improve the feasibility and impact of team-based learning during one-hour conferences.Trial registrationNot applicable.