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1.
Vascular ; 31(2): 369-374, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34958621

RESUMO

OBJECTIVES: This article aims to present a prospective study investigating the safety and efficacy of the Mynx Control extravascular closure device (Cordis Corporation, FL, USA), for femoral arterial closure in patients undergoing peripheral arterial procedures. METHODS: Between January 2020 and February 2021, 100 Mynx Control devices were deployed in 91 consecutive patients (mean age: 67.5 ± 16.9 years) who underwent peripheral arterial procedures. We used ultrasound and/or fluoroscopy during Mynx Control deployment and ultrasound post-procedure to detect complications. Femoral artery punctures included 62 (62%) antegrade and 38 (38%) retrograde punctures. The mean activated clotting time at time of device deployment was 221s. The primary endpoints were technical success, device failure, and complication rates up to 30 days. RESULTS: A 5F vascular sheath was used in 43 cases (43%) (36 (36%) 6F and 21 (21%) 7F). The majority of our cases had antegrade access (62%). Overall technical success rate was 97% in both antegrade and retrograde cases. In total, there were 4 minor complications: 3 (3%) cases of pseudoaneurysm and 1 (1%) case of haematoma. No major complications were recorded post-procedure or 30 days post index procedure. CONCLUSION: The Mynx Control vascular closure device is safe and effective in achieving haemostasis in patients undergoing antegrade and retrograde peripheral angioplasty procedures.


Assuntos
Dispositivos de Oclusão Vascular , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Prospectivos , Técnicas Hemostáticas/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Resultado do Tratamento , Desenho de Equipamento , Estudos Retrospectivos
2.
Acta Obstet Gynecol Scand ; 100(6): 1040-1050, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32865812

RESUMO

INTRODUCTION: Infection and inflammation have been implicated in the etiology and subsequent morbidity associated with preterm birth. At present, there are no tests to assess for fetal compartment infection. The thymus, a gland integral in the fetal immune system, has been shown to involute in animal models of antenatal infection, but its response in human fetuses has not been studied. This study aims: (a) to generate magnetic resonance imaging (MRI) -derived fetal thymus volumes standardized for fetal weight; (b) to compare standardized thymus volumes from fetuses that delivered before 32 weeks of gestation with fetuses that subsequently deliver at term; (c) to assess thymus size as a predictor of preterm birth; and (d) to correlate the presence of chorioamnionitis and funisitis at delivery with thymic volumes in utero in fetuses that subsequently deliver preterm. MATERIAL AND METHODS: Women at high-risk of preterm birth at 20-32 weeks of gestation were recruited. A control group was obtained from existing data sets acquired as part of three research studies. A fetal MRI was performed on a 1.5T or 3T MRI scanner: T2 weighted images were obtained of the entire uterine content and specifically the fetal thorax. A slice-to-volume registration method was used for reconstruction of three-dimensional images of the thorax. Thymus segmentations were performed manually. Body volumes were calculated by manual segmentation and thymus:body volume ratios were generated. Comparison of groups was performed using multiple regression analysis. Normal ranges were created for thymus volume and thymus:body volume ratios using the control data. Receiver operating curves (ROC) curves were generated for thymus:body volume ratio and gestation-adjusted thymus volume centiles as predictors of preterm birth. Placental histology was analyzed where available from pregnancies that delivered very preterm and the presence of chorioamnionitis/funisitis was noted. RESULTS: Normative ranges were created for thymus volume, and thymus volume was standardized for fetal size from fetuses that subsequently delivered at term, but were imaged at 20-32 weeks of gestation. Image data sets from 16 women that delivered <32 weeks of gestation (ten with ruptured membranes and six with intact membranes) and 80 control women that delivered >37 weeks were included. Mean gestation at MRI of the study group was 28+4  weeks (SD 3.2) and for the control group was 25+5  weeks (SD 2.4). Both absolute fetal thymus volumes and thymus:body volume ratios were smaller in fetuses that delivered preterm (P < .001). Of the 16 fetuses that delivered preterm, 13 had placental histology, 11 had chorioamnionitis, and 9 had funisitis. The strongest predictors of prematurity were the thymus volume Z-score and thymus:body volume ratio Z-score (ROC areas 0.915 and 0.870, respectively). CONCLUSIONS: We have produced MRI-derived normal ranges for fetal thymus and thymus:body volume ratios between 20 and 32 weeks of gestation. Fetuses that deliver very preterm had reduced thymus volumes when standardized for fetal size. A reduced thymus volume was also a predictor of spontaneous preterm delivery. Thymus volume may be a suitable marker of the fetal inflammatory response, although further work is needed to assess this, increasing the sample size to correlate the extent of chorioamnionitis with thymus size.


Assuntos
Nascimento Prematuro/diagnóstico por imagem , Timo/diagnóstico por imagem , Timo/fisiologia , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos de Casos e Controles , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Tamanho do Órgão/fisiologia , Projetos Piloto , Gravidez , Gravidez de Alto Risco , Timo/embriologia , Timo/patologia
3.
BMC Health Serv Res ; 18(1): 188, 2018 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-29554911

RESUMO

BACKGROUND: Workforce planning in the British healthcare system (NHS) is associated with significant costs of agency staff employment. The introduction of a novel software (ABG) as a 'people to people economy' (P2PE) platform for temporary staff recruitment offers a potential solution to this problem. Consequently, the focus of this study was twofold - primarily to explore the locum doctor landscape, and secondarily to evaluate the implementation of P2PE in the healthcare industry. METHODS: Documentary analysis was conducted alongside thirteen semi structured interviews across five informant groups: two industry experts, two healthcare consultants, an executive director, two speciality managers and six doctors. RESULTS: We found that locum doctors are indispensable to covering workforce shortages, yet existing planning and recruitment practices were found to be inefficient, inconsistent and lacking transparency. Contrarily, mobile-first solutions such as ABG seem to secure higher convenience, better transparency, cost and time efficiency. We also identified factors facilitating the successful diffusion of ABG; these were in line with classically cited characteristics of innovation such as trialability, observability, and scope for local reinvention. Drawing upon the concept of value-based healthcare coupled with the analysis of our findings led to the development of Information Exchange System (IES) model, a comprehensive framework allowing a thorough comparison of recruitment practices in healthcare. CONCLUSION: IES was used to evaluate ABG and its diffusion against other recruitment methods and ABG was found to outperform its alternatives, thus suggesting its potential to solve the staffing and cost crisis at the chosen hospital.


Assuntos
Mão de Obra em Saúde/organização & administração , Inovação Organizacional , Software , Medicina Estatal/economia , Medicina Estatal/organização & administração , Custos e Análise de Custo , Pesquisa sobre Serviços de Saúde , Humanos , Admissão e Escalonamento de Pessoal , Reino Unido
4.
Postgrad Med J ; 94(1111): 263-269, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29519810

RESUMO

BACKGROUND: Essential Skills in the Management of Surgical Cases (ESMSC) is a novel 3-day international undergraduate surgical masterclass. Its current curriculum (Cores integrated for Research-Ci4R) is built on a tetracore, multiclustered architecture combining high-fidelity and low-fidelity simulation-based learning (SBL), with applied and basic science case-based workshops, and non-technical skills modules. We aimed to report our experience in setting up ESMSC during the global financial crisis. METHODS: We report the evolution of our curriculum's methodology and summarised the research outcomes related to the objective performance improvement of delegates, the educational environment of the course and the use of mixed-fidelity SBL. Feedback from the last three series of the course was prospectively collected and analysed using univariate statistics on IBM SPSS V.23. RESULTS: 311 medical students across the European Union (EU) were selected from a competitive pool of 1280 applicants during seven series of the course between 2014 and 2017. During this period, curriculum 14 s evolved to the final Ci4R version, which integrates a tetracore structure combining 32 stations of in vivo, ex vivo and dry lab SBL with small group teaching workshops. Ci4R was positively perceived across different educational background students (p>0.05 for any comparison). CONCLUSIONS: ESMSC is considered an innovative and effective multidisciplinary teaching model by delegates, where it improves delegates objective performance in basic surgical skills. Our experience demonstrates provision of high-quality and free surgical education during a financial crisis, which evolved through a dynamic feedback mechanism. The prospective recording and subsequent analysis of curriculum evolution provides a blueprint to direct development of effective surgical education courses that can be adapted to local needs.


Assuntos
Currículo , Recessão Econômica , Educação de Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Adulto , Avaliação Educacional , União Europeia , Feminino , Grécia , Humanos , Masculino , Modelos Educacionais , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
5.
Acta Neurochir (Wien) ; 160(9): 1673-1679, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29968093

RESUMO

INTRODUCTION: Physiological hand tremor occurs naturally, due to oscillations of the upper extremities. Tremor can be exacerbated by stress and anxiety, interfering with fine motor tasks and potentially impact on surgical performance, particularly in microsurgery. We investigated the link between tremor, anxiety and performance in a neurosurgical module as part of an international surgical course. METHODS: Essential Skills in the Management of Surgical Cases (ESMSC) course recruits medical students from European Union (EU) medical schools. Students are asked to suture the dura mater in an ex vivo swine model, of which the first suture completed was assessed. Questionnaires were distributed before and after the module, eliciting tremor risk factors, self-perception of tremor and anxiety. Johnson O'Connor dexterity pad was used to objectively measure dexterity. Direct Observation of Procedural Skills (DOPS) was used to assess skills-based performance. Anxiety was assessed using the Westside Test Anxiety Scale (WTAS). Tremor was evaluated by four qualified neurosurgeons. RESULTS: Forty delegates participated in the study. Overall performance decreased with greater subjective perception of anxiety (p = 0.032, rho = - 0.392). Although increasing scores for tremor at rest and overall WTAS score were associated with decreased performance, this was not statistically significant (p > 0.05). Tremor at rest did not affect dexterity (p = 0.876, rho = - 0.027). CONCLUSIONS: Physiological tremor did not affect student performance and microsurgical dexterity in a simulation-based environment. Self-perception of anxiety affected performance in this module, suggesting that more confident students perform better in a simulated neurosurgical setting.


Assuntos
Ansiedade/psicologia , Educação de Graduação em Medicina/métodos , Destreza Motora , Neurocirurgia/educação , Tremor/psicologia , Educação de Graduação em Medicina/normas , União Europeia , Humanos , Estudantes de Medicina/psicologia
6.
Br J Radiol ; 95(1136): 20210726, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35616650

RESUMO

OBJECTIVE: This study sought to examine international interventional radiology (IR) training standards and perceptions. This survey aims to identify gender-based barriers and inequities effecting uptake, retention and experience of trainees in IR. METHODS: An anonymous survey was created using Survey Monkey and distributed as a single-use weblink via eight IR national and international societies around the world. Data analysis was conducted to highlight gender-specific trends and identify any differences. RESULTS: Motivation factors given for following a career in IR revealed gender differences in factors such as mentoring (8.7 F vs 21.6% M) and influence from senior colleagues (15.2 F vs 25.0% M). The overwhelming majority across both genders (82.6 F vs 81.3% M) agreed or strongly agreed that early exposure to IR training at Year 1 had a positive impact on career choice. A good work life balance was positively reported in 48.2% of female respondents compared to 45.2% in males. There were no significant differences in satisfaction with the various aspects of IR training. All differences observed between genders, exceeded the 0.05 significance level. CONCLUSION: This survey offers many insights into the current international landscape of IR training. Ongoing evaluation is vital to inform recruitment practices and initiatives to bridge gender inequities and attract more females into IR. ADVANCES IN KNOWLEDGE: This study has revealed that increasing and optimising mentoring opportunities may be the first step in increasing awareness of IR and maximising potential female recruits.


Assuntos
Internato e Residência , Radiologia Intervencionista , Animais , Escolha da Profissão , Feminino , Masculino , Radiologia Intervencionista/educação , Fatores Sexuais , Inquéritos e Questionários
7.
J Vasc Surg Venous Lymphat Disord ; 10(3): 607-616.e2, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34508871

RESUMO

OBJECTIVE: In the present study, we evaluated the technical and clinical outcomes after endovascular inferior vena cava (IVC) reconstruction in patients with nonmalignant obstruction. METHODS: The preoperative, procedural, and follow-up medical records and imaging studies were retrospectively reviewed for 59 consecutive patients who had undergone endovascular IVC reconstruction for nonmalignant obstruction from February 2014 to January 2019. The patients were classified into three groups according to the quality of their infrainguinal inflow vessels. The outcomes measured were the primary, primary-assisted, and secondary patency rates, reintervention rates, and symptomatic resolution. RESULTS: The indications for treatment were post-thrombotic syndrome (n = 41), acute deep vein thrombosis (n = 12), and retroperitoneal fibrosis (n = 6). The median patient age was 37 years, 11 months, 71.2% were men, and 32.2% had a diagnosis of thrombophilia, with no significant difference in these demographics between the three inflow groups. The median follow-up duration was 2 years, 3 months (range, 6 months to 6 years, 5 months). The whole-cohort primary patency was 91.2%, 71.0%, and 24.1% at 1, 3, and 5 years, respectively. Secondary patency was 76.7% at 1 year and 66.4% at both 3 and 5 years. Inflow group A (no post-thrombotic disease in the femoral or deep femoral veins) demonstrated significantly higher primary patency compared with group B (stenotic disease in one or two infrainguinal inflow veins; P = .009) and significantly higher secondary patency than for both groups B (P = .008) and C (all three infrainguinal inflow veins had stenosed or femoral and/or deep femoral vein occlusion was present; P = .04). In post-thrombotic syndrome patients, the Villalta scores had decreased from a mean of 14.2 to 8.1 at 1 year and 6.8 at 2 years, and the Venous Insufficiency Epidemiological and Economic Study Quality of Life score had improved from a mean of 19.8 to 54.1 and 57.3 at 1 and 2 years, respectively. In the patients with acute deep vein thrombosis, the Villalta score was 2.8 at 1 year and 0 at 2 years. In the patients with retroperitoneal fibrosis, the Venous Insufficiency Epidemiological and Economic Study Quality of Life score had improved from a mean of 25.3 at baseline to 44 at 6 months. CONCLUSIONS: Endovascular IVC reconstruction for nonmalignant obstruction can achieve good patency and clinical improvement, although the outcomes were poorer for patients with post-thrombotic disease of the femoral and deep femoral veins.


Assuntos
Síndrome Pós-Trombótica , Fibrose Retroperitoneal , Insuficiência Venosa , Trombose Venosa , Adulto , Doença Crônica , Constrição Patológica/cirurgia , Feminino , Humanos , Veia Ilíaca/cirurgia , Masculino , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgia
8.
Br J Radiol ; 95(1129): 20210727, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34591603

RESUMO

OBJECTIVE: Implementing a streamlined interventional radiology (IR) service in the UK has been a challenge. This study aims to review a set of changes introduced in IR at a tertiary centre, including a new referral process and the designation of IR clinical nurse specialists. METHODS: A new process of referring patients to IR using a single generic referral pathway was implemented, replacing an order dropdown-based system. A qualitative survey was designed and distributed as a single-use web link in order to assess the satisfaction and impact of this new process. Responses were based on Likert scale and pertained to perceived qualities of the new referral process. Data analysis was performed to identify specialty and grade-specific trends and possible differences amongst groups. RESULTS: Findings from 98 respondents revealed a strong overall satisfaction with the new referral method and support for its continuation. Subgroup analysis by specialty, concluded medical specialties rated the new referral system more favourably than surgical specialties across all aspects: time efficiency, ease of use, periprocedural support and overall user experience. The new system also increased departmental productivity with an increase in the number of patients treated by 11.2%. CONCLUSION: Micropolicy changes within individual IR departments such as the replacement of a request-based referral system to one which puts IR in control of vetting and patient flow is one of many changes that reinforce the transformational phase of this specialty. ADVANCES IN KNOWLEDGE: Micropolicy changes within IR departments are key in the progression and widespread recognition of the specialty.


Assuntos
Radiologia Intervencionista/organização & administração , Encaminhamento e Consulta/organização & administração , Humanos , Corpo Clínico Hospitalar , Enfermeiros Clínicos , Recursos Humanos de Enfermagem Hospitalar , Satisfação do Paciente , Centros de Atenção Terciária , Reino Unido
9.
Br J Radiol ; 94(1117): 20200581, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33252988

RESUMO

Coronavirus disease 19 (Covid-19) poses a huge threat to health systems and economies worldwide. So far, there has been no proven effective treatment for SARS-CoV-2 infection. Various potential therapies, viz., immunomodulatory agents, antiviral therapy, and plasma transfusion, are undergoing clinical trials. An intensive search of the medical corpora revealed that low dose X-ray radiation therapy has been used in the past to treat interstitial pneumonia. In this article we explore a historical background of low-dose X-rays for the treatment of pneumonia and how it could be a promising therapy in treating patients with COVID-19.


Assuntos
COVID-19/radioterapia , Terapia por Raios X/métodos , História do Século XX , Humanos , Dosagem Radioterapêutica , Terapia por Raios X/história
10.
In Vivo ; 35(1): 1-12, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33402444

RESUMO

AIM: This systematic review aimed to identify all published evidence on teaching suturing skills for medical students. We aimed to outline significant positive teaching outcomes and devise a comprehensive framework for the optimal teaching of suturing skills for medical students. MATERIALS AND METHODS: We searched MEDLINE® (via Ovid), EMBASE and SCOPUS databases until July 2019 with no language restriction using predefined 'Population, Intervention, Comparison, Outcome (PICO)' criteria. Data were summarised in discrete thematic axes using a qualitative synthesis approach. RESULTS: Our search yielded a total of 2,562 articles, out of which 25 were included in the final data synthesis. We provide a structured breakdown of educational interventions including participants, instructors and nature of teaching intervention. We also describe discrete means for assessment of performance and retention of suturing skills. Based on those we propose a standardised framework on teaching suturing skills for novices. CONCLUSION: To our knowledge this is the first systematic review investigating teaching interventions used to teach suturing skills in medical students. After extraction of individual positive teaching outcomes and utilising widely known learning theories and principles, we devised a comprehensive framework for more efficient and cost-effective teaching of suturing skills to medical students in the future.


Assuntos
Estudantes de Medicina , Humanos
11.
Cardiovasc Intervent Radiol ; 44(2): 300-307, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33034702

RESUMO

BACKGROUND: The interventional radiology (IR) trainee recruitment in the UK is lagging behind the pace of service expansion and is potentially hindered by underrepresented undergraduate curricula. Understanding the contributing factors that encourage junior doctors and medical students to consider an IR career will help the IR community to better focus the efforts on recruiting and nurturing the next generation. METHODS: Anonymised questionnaires on undergraduate and postgraduate IR exposure were distributed to attendees of five UK IR symposia between 2019 and 2020. RESULTS: 220 responses were received from 103 (47%) junior doctors and 117 (53%) medical students. Prior IR exposure strongly correlates with individuals' positive views towards an IR career (Pearson's R = 0.40, p < 0.001), with involvement in clinical activities as the most important independent contributor (OR 3.6, 95%CI 1.21-10.50, p = 0.021). Longer time spent in IR (especially as elective modules) and IR-related portfolio-building experiences (such as participating in research, attending conferences and obtaining career guidance) demonstrate strong association with willingness to pursue an IR career for the more motivated (p values < 0.05). The symposia had overall positive effects on subjective likelihood to pursue an IR career, particularly among junior doctors who face near-term career choices (p < 0.001). CONCLUSION: Our study, focusing on a self-selected cohort, identified contributing factors to individuals' willingness to pursue an IR career. Symposia have additional recruitment effects in extra-curricular settings. Active engagement with junior doctors and medical students through clinical activities and non-clinical portfolio-related experiences are key to generate informed and motivated candidates for the future of IR.


Assuntos
Escolha da Profissão , Corpo Clínico Hospitalar/estatística & dados numéricos , Radiologistas/educação , Radiologistas/estatística & dados numéricos , Radiologia Intervencionista/educação , Estudantes de Medicina/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/educação , Inquéritos e Questionários , Reino Unido
12.
J Invest Surg ; 34(1): 39-43, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31035823

RESUMO

Aim of the study: Introduction of non-technical skill (NTS) modules in undergraduate medical curricula is essential to prevent errors that occur due to inadequate communication and malfunctioning teams. We primarily aimed to observe medical students' NTS performance improvement in a group-based setting and compare it across participants of different countries of study. Secondarily, we aimed to assess students' views on such initiatives. Material and Methods: We designed a pilot module for assessing and improving a group's NTS performance. This was based on three main pillars: simulation-based learning, constructive feedback and objective assessment. Senior medical students from EU universities were invited to apply online. Delegates were divided according to their country of study and participated in two surgical scenarios. Groups had two attempts at each scenario and feedback was given in between. Performance was assessed using a modified version of the Individual Teamwork Observation and Feedback Tool (iTOFT). Participant feedback was collected at the end of the module. Results: Eighty delegates were recruited and finished the study. A mean increase performance of 0.81 out of 3 was noted between attempts in trauma-case scenarios and 0.88 out of 3 in ward round scenarios. Overall performance improvement was similar across all groups (p > 0.05). Feedback of delegates was encouragingly positive. Conclusions: The reported improvement and positive feedback received highlight that such an intervention can be implemented in medical school curricula of all countries. Our module design, along with the use of iTOFT, should act as the basis for future development of group-based learning and assessment in undergraduate medical education.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Currículo , Humanos
13.
CVIR Endovasc ; 3(1): 70, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32965530

RESUMO

BACKGROUND: On the background of the interventional radiology department of a tertiary hospital converting its periprocedural documentation from paper-based to electronic using a standardised proforma, a study was performed to ascertain the effects of this change on the standard of clinical documentation for radiologically-guided angiographic procedures. Using a retrospective approach, perioperative records were analysed in reverse chronological order for inclusion in the study. The standard for this audit was developed in the form of minimum criteria that all clinical documentation of angiographic procedures were expected to meet. RESULTS: The audit was performed at three equally spaced intervals of 6 months, yielding a total of 99 records. The baseline audit of paper-based records concluded > 80% completeness for 8 out of the 14 of parameters measured, with only two of parameters meeting the target of 100% completeness. The second audit cycle performed on electronic records found 7 out of 14 parameters demonstrating absolute improvement in completeness, when compared to paper-based, but with the number of parameters exceeding 80% completeness falling to only 4 out of 14. Again, 100% completeness was observed in only 2 of the parameters. In the final audit cycle, after the introduction of a standardised electronic proforma, performance improved in every dimension with 6 out of 14 parameters reaching completeness of 100% and the 80% completeness threshold met by 12 out of 14 parameters. CONCLUSION: The construction of a procedure-specific perioperative electronic proforma can save clinicians valuable time and encourage safe and effective clinical documentation.

14.
CVIR Endovasc ; 3(1): 12, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32147761

RESUMO

BACKGROUND: Interventional radiology (IR) is underrepresented in undergraduate medical curricula across Europe. By continuing to challenge the boundaries of IR, a rise in the demand for radiologists has been inevitable - a trend not met by a corresponding rise in the supply of radiologists. On tracing the roots of this shortage, lack of awareness of the specialty within medical trainees coupled with a global lack of IR teaching in undergraduate education seem to constitute major exacerbating factors. The purpose of this study was to identify gaps in the field of IR education and address these by implementing an international IR simulation-based course for undergraduates. RESULTS: Implementation of a multi-modality simulation-based course consisted of seven modules incorporating technical and non-technical skills, basic science and applied clinical science modules. Of all participants, 90.7% (N = 68) never had previous IR teaching experience and only 28% (N = 21) had a previous placement in an IR department. Following the course, confidence improvement was statistically significant both in IR skills (1/5, p < 0.01) and knowledge (1/5, p < 0.01)]. The majority (90.7%) said they would benefit with more exposure to IR. In terms of the students' motivation for a career in IR, 32% (N = 24) reported that they would more likely consider a career in IR after completing the course. CONCLUSION: Delivery of a tetra-core simulation course with the aim to address the gaps in undergraduate IR education has had a positive impact on students' skills, confidence levels as well as motivation. We propose reviewing the curricula across medical schools in Europe to identify gaps and address any inadequacies; for this, we consider our simulation course an excellent starting point.

15.
BMJ Open ; 10(2): e033181, 2020 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041855

RESUMO

OBJECTIVES: Faced with a costly and demanding learning curve of surgical skills acquisition, the growing necessity for improved surgical curricula has now become irrefutable. We took this opportunity to formulate a teaching framework with the capacity to provide holistic surgical education at the undergraduate level. SETTING: Data collection was conducted in all the relevant healthcare centres the participants worked in. Where this was not possible, interviews were held in quiet public places. PARTICIPANTS: We performed an in-depth retrospective evaluation of a proposed curriculum, through semi-structured interviews with 10 participants. A targeted sampling technique was employed in order to identify senior academics with specialist knowledge in surgical education. Recruitment was ceased on reaching data saturation after which thematic data analysis was performed using NVivo 11. RESULTS: Thematic analysis yielded a total of 4 main themes and 29 daughter nodes. Majority of study participants agreed that the current landscape of basic surgical education is deficient at multiple levels. While simulation cannot replace surgical skills acquisition taking place in operating rooms, it can be catalytic in the transition of students to postgraduate training. Our study concluded that a standardised format of surgical teaching is essential, and that the Integrated Generation 4 (IG4) framework provides an excellent starting point. CONCLUSIONS: Through expert opinion, IG4 has been validated for its capacity to effectively accommodate learning in a safer and more efficacious environment. Moreover, we support that through dissemination of IG4, we can instil a sense of motivation to students as well as develop robust data sets, which will be amenable to data analysis through the application of more sophisticated methodologies.


Assuntos
Competência Clínica , Currículo , Educação de Graduação em Medicina/métodos , Cirurgia Geral/educação , Aprendizagem , Ensino , Adulto , Simulação por Computador , Educação de Pós-Graduação em Medicina , Humanos , Estudantes de Medicina , Inquéritos e Questionários
16.
Ann Med Surg (Lond) ; 55: 308-315, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551104

RESUMO

OBJECTIVES: The aim of this study is to evaluate a simulation-based team performance course for medical students and compare its low- and high-fidelity components. STUDY DESIGN: This is a prospective crossover observational study. Groups participated in one low- and one high-fidelity session twice. Low-fidelity scenarios included management of an emergency case on a simulated-patient, whereas high-fidelity scenarios constituted of multiple-trauma cases where simulated-patients wore a hyper-realistic suit. Team performance was assessed objectively, using the TEAM™ tool, and subjectively using questionnaires. Questionnaires were also used to assess presence levels, stress levels and evaluate the course. RESULTS: Participants' team performance was higher in the low-fidelity intervention as assessed by the TEAM™ tool. An overall mean increase in self-assessed confidence towards non-technical skills attitudes was noted after the course, however there was no difference in self-assessed performance between the two interventions. Both reported mean stress and presence levels were higher for the high-fidelity module. Evaluation scores for all individual items of the questionnaire were ≥4.60 in both NTS modules. Students have assessed the high-fidelity module higher (4.88 out of 5, SD = 0.29) compared to low-fidelity module (4.74 out of 5, SD = 0.67). CONCLUSIONS: Both the low- and high-fidelity interventions demonstrated an improvement in team performance of the attending medical students. The high-fidelity intervention was more realistic, yet more stressful. Furthermore, it proved to be superior in harvesting leadership, teamwork and task management skills. Both modules were evaluated highly by the students, however, future research should address retention of the taught skills and adaptability of such interventions.

17.
CVIR Endovasc ; 3(1): 9, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32064540

RESUMO

BACKGROUND: Iodinated contrast media are amongst the most frequently prescribed medications, however, their use is not without complications. With contrast-induced nephropathy constituting a major concern, alternative non-iodine based approaches have been explored such as carbon dioxide angiography. The purpose of this study is to report the incidence of contrast-induced nephropathy following carbon dioxide angiography in patients with impaired renal function that underwent peripheral angioplasty compared with a historical cohort of patients that underwent angioplasty with use of solely iodine contrast medium. The historical cohort of patients treated with iodinated contrast was used as control. Baseline demographics and renal function tests were recorded. Primary outcome was incidence of contrast-induced nephropathy within 48-72 h post intervention. Receiver-Operating-Characteristic curve analysis was used to correlate the volume of iodinated contrast with the risk of contrast-induced nephropathy. RESULTS: Carbon Dioxide was used as an alternative to iodinated contrast media in patients with impaired renal function (eGFR<60mls/min/1.73 m2) undergoing peripheral angioplasty procedures. Fifty, consecutive patients (baseline eGFR = 38.6 ± 13.2mls/min/1.73 m2) were included in a prospective clinical audit. These were matched (1:2) with a historical cohort of patients (baseline eGFR = 43.3 ± 12.2mls/min/1.73 m2) treated with Iodinated contrast media. The incidence of contrast-induced nephropathy was 14% (n = 7/50) in case of carbon dioxide vs. 29% (n = 29/100) in the matched cohort group (p = 0.045). Receiver-Operating-Characteristic analysis showed that use of >25mls of contrast was 94.4% (95% CI:81-99%) sensitive in predicting contrast-induced nephropathy. CONCLUSION: Carbon dioxide imaging during peripheral angioplasty procedures protects against contrast-induced nephropathy. Use of >25mls of iodinated contrast media in high-risk patients is a predictor of contrast-induced nephropathy.

18.
In Vivo ; 34(3): 1063-1069, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354893

RESUMO

AIM: Essential Skills in the Management of Surgical Cases (ESMSC Marathon Course™) Integrated Generation 4 (iG4) is the first reported multifaceted undergraduate surgical course aiming to provide holistic surgical teaching. In this prospective observational study, we explored students' views on the iG4 curriculum, and identified how it can potentially address modern challenges in surgical training. MATERIAL AND METHODS: Medical students were invited to apply to the course online and were screened against pre-defined criteria. A multi-national structured questionnaire incorporating five domains related to the course curriculum and our dedicated research network, was designed and distributed to participants after successful completion of the course. RESULTS: Forty-one students from European and Asian medical schools completed the course and filled in the survey. The median overall evaluation score of the course was 4.73 out of 5 (interquartile range=4.21-4.72) and all students found that iG4 served the vision of holistic surgical education. ESMSC had a positive motivational effect towards following a career in surgery (p=0.012) and 92.7% of students declared that it should be an essential part of a future medical school curriculum. There was no statistically significant difference (p>0.05) in results between participants of different countries of study, year of studies or age group. CONCLUSION: The ESMSC Marathon Course™ is perceived as a unique course model, with an established educational value and a positive motivational effect towards surgery. It might potentially be implemented in future medical school curricula as an essential element of undergraduate surgical education. The iG4 curriculum has opened a new exciting horizon of opportunities for advancing undergraduate holistic surgical education.


Assuntos
Currículo , Cirurgia Geral/educação , Saúde Holística/educação , Estudantes de Medicina , Feminino , Humanos , Masculino , Inquéritos e Questionários , Reino Unido
19.
Artigo em Inglês | MEDLINE | ID: mdl-31281564

RESUMO

PURPOSE OF REVIEW: The purpose of this paper is to review current and new modalities to image key biological processes in ischemic heart disease and after myocardial infarction non-invasively. RECENT FINDINGS: New imaging targets have been developed to detect and quantify myocardial damage after ischemia. Although positron emission tomography (PET) has been leading the development of new probes in the past, continuous improvements of magnetic resonance imaging (MRI) together with the development of new novel MRI contrast agents opens new research avenues including the combination of both PET and MRI to obtain anatomic, functional, and molecular information simultaneously, which is not possible from a single imaging session. SUMMARY: This review summarizes the state of art of non-invasive molecular imaging of the myocardium during ischemia and after myocardial infarction using PET and MRI. We also describe the different contrast agents that have been developed to image the different phases of cardiac healing and the biological processes associated with each of those phases. Importantly, here we focus on imaging of inflammation as it is the key biological process that orchestrates clearance of dead cells, tissue remodeling, cardiac repair, and future outcome. We also focus on clinical translation of some of the novel contrast agents that have been tested in patients and discuss the need for larger, multi-center patient studies to fully validate the applicability of new imaging probes.

20.
Interact Cardiovasc Thorac Surg ; 29(6): 911-922, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504555

RESUMO

In aortic root aneurysms, the challenge of a valve-sparing aortic root replacement (VSRR) procedure is to ensure durable aortic valve function without reintervention. Although the Bentall procedure defers the durability of valve function to the prosthesis, short- and long-term complications tend to be higher. The aim of this study was to compare the outcomes of VSRR and Bentall procedures in patients with aortic root aneurysms. A systematic literature review was conducted using PubMed regarding the outcomes of the Bentall procedure compared with those of VSRR from the inception of the 2 procedures until July 2018. Studies with short- and long-term comparative data were included. An initial search yielded 9517 titles. Thirty-four studies were finally included for meta-analysis (all retrospective, non-randomized), comprising 7313 patients (2944 valve-sparing and 4369 Bentall procedures) with no evidence of publication bias. Operative mortality was found to be significantly lower in the VSRR group [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37-0.70; P < 0.001] despite overall higher cardiopulmonary bypass and aortic cross-clamp times. The 5-year survival rate was also more favourable in the VSRR group (OR 1.93 95% CI 1.15-3.23; P < 0.05). Significantly lower rates of cerebral thromboembolism (OR 0.668, 95% CI 0.477-0.935; P = 0.019) and heart block (OR 0.386, 95% CI 0.195-0.767; P = 0.007) were also found after VSRR. There was no significant difference in rates of reoperation between the groups at long-term follow-up (OR 1.32, 95% CI 0.75-2.33; P = 0.336). Meta-regression of patient and operative covariates yielded no influence on the main outcomes (P > 0.05). These findings suggest that VSRR is an appropriate and potentially better treatment option for a root aneurysm when the aortic valve is repairable.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma da Aorta Torácica/complicações , Insuficiência da Valva Aórtica/etiologia , Humanos
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