Impact of bedside ultrasound to reduce the incidence of acute renal injury in high-risk surgical patients: a randomized clinical trial.

PURPOSE: This study aimed to determine whether performing bedside ultrasound impacts the occurrence of acute kidney injury (AKI) in the immediate postoperative period (POP) of high-risk surgery patients. METHODS: POP patients were randomly assigned to two groups: (i) ultrasound (US) group, in which hemodynamic management was guided with clinical parameters supplemented with the bedside US findings; (ii) control group, hemodynamic management based solely on clinical parameters. Two exams were performed in the first 24 h of admission. RESULTS: Fifty-one patients were randomized to the US group and 60 to the control group. There was no significant difference for incidence of AKI in both groups assessed 12 h (31.4% vs 35.0%, P = 0.84), 24 h (27.5% vs 23.3%, P = 0.66), or 7 days (17.6 vs 8.3%, P = 0.16) after surgery. No difference was found in the amounts of volume administered over the first 12 h (1000 [500-2000] vs. 1000 [500-1500], P = 0.72) and 24 h (1000 [0-1500] vs. 1000 [0-1500], P = 0.95) between the groups. Patients without AKI in the control group received higher amounts of volume during the ICU stay. CONCLUSION: The use of bedside US in the immediate postoperative period of high-risk surgery did not show benefits in reducing AKI incidence.

Development and application of a massive open online course to deliver innovative transplant education.

Massive Open Online Courses (MOOCs) offer an entirely new course concept for delivering content and engaging learners. This method of teaching has huge potential for the field of transplant education. In this study we describe the development and implementation of the MOOC "Clinical Kidney, Pancreas and Islet Transplantation". Three and a half years after the introduction of the course, the learning demographics have been analyzed. The majority of learners were from Europe, North America and Asia. The course has been offered at several different stages of education at Leiden University Medical Center from undergraduate to continuous medical education. The level of engagement with the content was associated with the background and motivations of the learners. 74% had a bachelor's degree or higher. 48% of the undergraduate students participated in other content than instructed. Learners reported having liked the design of the course. Personal growth was the main motivation for 93% of worldwide learners. 69% considered the content of the MOOC to be relevant to their job. In general student's intentions focused more on reasons of personal growth, general interest, and relevance to school or degree program. Overall the integration of the MOOC in different settings of formal transplant education offered an added value to the on-campus program.

Five-year review of an international clinical research-training program.

The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background.