Utilizing Audience Response to Foster Evidence-based Learning in a Pilot Study: Does It Really Work?

Introduction Radiology residency programs are increasingly using audience response systems (ARS) in educational lectures. It is imperative that this is investigated to assess if learning outcomes in trainees are actually improved. Methods The primary objective of this randomized prospective unblinded pilot study was to assess the effect of ARS on long-term learning outcomes, with a secondary objective of understanding perceptions of ARS amongst radiology residents. Twenty-two radiology residents were randomized into two groups of 11 residents each receiving five identical musculoskeletal (MSK) radiology lectures. One group received lectures through ARS and the other through traditional didactics. A pretest and identical posttest were completed by all residents at baseline and eight months later, respectively. Residents also completed a pre and post five-question Likert scale survey designed to measure perceptions of ARS. Results Wilcoxon rank sum tests revealed no statistically significant difference between the two groups of residents on the pretest (p = 0.47) or the posttest (p = 0.41). Of the five questions designed to gauge perceptions of ARS, "How often do you study radiology outside of work?" resulted in statistical significance between groups after the lecture series via ordinal logistic regression, with the ARS group six times more likely to study compared to the non-ARS group (Odds ratio = 6.52, P = 0.04, 95% Confidence Interval [1.1, 38.2]). There was no statistical difference in response to this question prior to the lecture series. Discussion Use of ARS was associated with increased likelihood of studying radiology without significant difference in long-term learning outcomes.

Transjugular intrahepatic porto-systemic shunt in the elderly: Palliation for complications of portal hypertension.

AIM: To present a dedicated series of transjugular intrahepatic porto-systemic shunts (TIPS) in the elderly since data is sparse on this population group. METHODS: A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010. Twenty-five patients were referred for TIPS. We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease. Of the 23 patients suitable for TIPS, the indications for TIPS placement was portal hypertension complicated by refractory ascites alone (n = 9), hepatic hydrothorax alone (n = 2), refractory ascites and hydrothorax (n = 1), gastrointestinal bleeding alone (n = 8), gastrointestinal bleeding and ascites (n = 3). RESULTS: Of these 23 attempted TIPS procedure patients, 21 patients had technically successful TIPS procedures. A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years (range 65-82 years). Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS. Sixteen of 21 patients who underwent successful TIPS (excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo. Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients. Bleeding was controlled following technically successful procedures in 10 out of 11 patients. CONCLUSION: We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.

Subclavian stenting in a hostile aortic arch facilitated by a low-profile brachial artery through-and-through access.

Subclavian stenting can be extremely difficult in a hostile type II aortic arch (with acute angulation of the subclavian artery origin) or type III aortic arch. This case illustrates use of a low-profile system to gain through-and-through (flossing) access through the brachial artery to facilitate stenting via the femoral approach. This approach can be useful in patients with small brachial arteries where the risk of complication may be high if a standard vascular sheath was placed for stenting via the brachial approach. This technique also avoids the use of a surgical cut down.

Renal vein stenting via the right internal jugular approach with a provocative Valsalva maneuver to reduce the risk of stent migration.

An adult male with nutcracker syndrome was treated successfully by placement of a self-expanding stent in the left renal vein via a right internal jugular vein approach with a provocative Valsalva maneuver. Previous case reports have described renal vein stenting for this condition via common femoral vein approach. However, this study proposes the right internal jugular vein approach as a safer method for the treatment of nutcracker syndrome since the stent can be easily captured along the guidewire if undersized. This technique is based on the realization that the left renal vein diameter may increase by 50% to 58% during the Valsalva maneuver.

Acute renal artery thrombosis treated with t-PA power-pulse spray rheolytic thrombectomy.

PURPOSE: To describe a new application of tissue plasminogen activator (t-PA) power-pulse spray rheolytic (pharmacomechanical) thrombectomy in the treatment of acute renal artery thrombosis. CASE REPORT: Acute renal artery thrombosis is a relatively rare, but serious condition in which it is imperative to restore perfusion as quickly as possible. Percutaneous pharmacomechanical thrombectomy technique was utilized to provide an effective means of restoring renal flow and function. We therefore present two unique cases of spontaneous and iatrogenic renal artery thromboses that were treated successfully with t-PA power-pulse spray rheolytic thrombectomy. CONCLUSION: t-PA Power-pulse spray rheolytic (pharmacomechanical) thrombectomy has the potential to be a useful means to restore perfusion and function in the setting of acute renal artery thrombosis.