Frequency and determinants of technical procedures in French general practice: a cross-sectional study.

INTRODUCTION: Technical skills have many areas of application in general practice and are a dimension of medical competence. Several studies have attempted to describe the technical procedures performed in general practice but most had limitations in the data collection process, the scope of the procedures addressed, or the healthcare actors involved. No French comparable data have been published. The aim of the present study was therefore to describe the frequency and type of technical procedures in French general practice, and to assess their determinants, in particular rurality. METHODS: The present study was ancillary to the ECOGEN (Eléments de la COnsultation en médecine GENérale) study, which was an observational cross-sectional, multicentre, nationwide study conducted in 128 French general practices. Data were collected on 20 613 patient-GP encounters, including the characteristics of GPs and encounters, as well as the health problems managed during the encounter and their associated processes of care; the latter two variables were coded according to the International Classification of Primary Care classification. The GPs' practice location was first classified as rural area, urban cluster, or urban area; the former two categories were combined for analysis. The various technical procedures were classified according to the framework of the International Classification of Process in Primary Care. The frequency of each technical procedure was compared according to GP practice location. The dependent variable analysed was the performance of at least one technical procedure per each health problem managed. Bivariate analysis was performed for all independent variables followed by multivariate analysis for key variables, using a hierarchical model including three levels: the physician, the encounter, the health problem managed. RESULTS: The data included 2202 technical procedures performed. At least one technical procedure was performed in 9.9% of encounters and for 4.6% of health problems managed. The two most frequent groups of technical procedures performed were injections (44.2% of all procedures) and clinical laboratory procedures (17.0%). The following procedures were more often performed by GPs practicing in a rural area or an urban cluster than those practicing in an urban area: injection of joints, bursae, tendons and tendon sheaths (4.1% v 1.2% of all procedures), manipulation and osteopathy (10.3% v 0.4%), excision/biopsy of superficial lesions (1.7% v 0.5%), and cryotherapy (1.7% v 0.3%). Conversely, the following procedures were more often performed by GPs practicing in urban areas: vaccine injection (46.6% v 32.1%), point-of-care testing for group A streptococci (11.8% v 7.6%), and ECG (7.6% v 4.3%). GPs practicing in a rural area or an urban cluster performed more often technical procedures than those practising in an urban area (odds ratio=1.31, 95% confidence interval 1.04-1.65), according to the multivariate model. CONCLUSION: Technical procedures were more frequently performed and more complex when they were performed in French rural and urban cluster areas. More studies are required to assess patients' needs regarding technical procedures.

Exploring training needs of newly graduated medical doctors to inform the undergraduate simulation-based curriculum: a national Delphi consensus study.

PURPOSE: Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors. METHODS: We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures. RESULTS: In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture. CONCLUSION: Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education.

Minimally Invasive Cytopathology and Accurate Diagnosis: Technical Procedures and Ancillary Techniques.

In recent years, the demand for cytopathological accurate diagnoses has increased as expanding minimally invasive procedures obtain materials from patients with advanced cancer for diagnostic, prognostic, and predictive purposes. However, inadequate knowledge of cytopathological technical procedures and ancillary techniques by clinicians remains the most common reason for the limited availability of cytopathology. The objectives of this review were to understand the technical procedures, ancillary techniques, and application and effectiveness of various types of tests in cytopathology. Each of the many ancillary technologies described in the literature has specific advantages and limitations and laboratories select one or more methods depending on their infrastructure and expertise to achieve the goal from initial screening of the disease to the final diagnosis of the cytopathology. This paper systematically reviews the development of cytopathology, summarizes the existing problems in cytopathology and the new progress of auxiliary examination, to provide a theoretical basis for the advanced development of cytopathological diagnostic technologies and to consolidate the minimally invasive and accurate diagnosis of cytopathologies for clinicians. Cytopathology offers many advantages over other clinical examinations, particularly for minimally invasive and accurate diagnosis.

A national needs assessment to identify technical procedures in plastic surgery for simulation-based training.

Medical simulation is not developed and integrated into plastic surgery unlike other surgical specialties despite the procedures being complex and require practice. First step in enhancing simulation in plastic surgery is to clarify the need among peers. The objective of the study was to identify and prioritize the technical procedures that should be included in a simulation-based curriculum for residency training in plastic surgery. A panel of participants with key roles in the Danish plastic surgery specialist training program was appointed. Participation was voluntary. A national need assessment study was performed using a three-round Delphi process to collect information from the participants. In round 1, participants reported all the procedures that a newly qualified specialist in plastic surgery should be able to perform. In round 2, participants replied to a survey exploring the frequency of the procedures, the number of surgeons performing the procedure, the risk or discomfort for patients treated by an inexperienced surgeon and the feasibility of training the procedure in simulation, resulting in a preliminary ranking of procedures. In round 3, participants eliminated and reprioritized the identified procedures according to importance. Thirty-five of 37 agreed to enter the expert panel. The response rate was 97%, 86% and 86% for rounds 1, 2 and 3, respectively. Twenty-nine of 136 procedures identified in round 1 reached the final prioritized list of procedures relevant for simulation training in plastic surgery.

Structured and evidence-based training of technical skills in respiratory medicine and thoracic surgery.

Within the last decade, the number of technical procedures in respiratory medicine and thoracic surgery has grown and created a higher demand for effective and evidence-based education. Today, trainees are often allowed to perform procedures unsupervised on patients after obtaining a course certificate from a theoretic course and having performed a fixed number of supervised procedures. However, these methods do not ensure adequate competence. Well-structured and effective educational programmes including validated tests are needed to reduce economic expenses, optimize time spend, and ensure patient safety. The aim of this article is to summarize current state of educational strategies for technical procedures within respiratory medicine and thoracic surgery. Thus, to discuss future recommendations for curriculum development and assessment of competences based on Kern's framework. The approach by Kern consists of six topics, which needs to be considered and evaluated and in order to educate physicians and surgeons most effective and evidence-based. We present a practical guide contributing to future educators' considerations on (I) problem identification and general needs assessment, (II) targeted needs assessment, (III) goals and objectives, (IV) educational strategies, (V) implementation, and finally (VI) evaluation and feedback.

How Dentists Read a Technique Article: A Grounded Theory Investigation.

PURPOSE: To conduct an empirical investigation using qualitative techniques of the way dentists engage in the process of reading a technique-oriented journal article and what they pay attention to in the process. MATERIALS AND METHODS: Grounded theory was used to identify how dentists read an article describing the fabrication of an interim prosthesis in the esthetic zone. Twenty-one experienced practitioners were videotaped, and their verbatim reflections were coded. The sequence of attending to various features of the paper was noted. RESULTS: Ninety-five percent of readers voiced specific, multiple attempts to identify or refine the main purpose of the article as they processed the material. All readers engaged in various activities to navigate through the article, including skipping and backtracking, and none "read" the article straight through. All readers also made repeated observations about the relevance of the technique to their personal practice situation. Eighty percent used some form of "distancing," whereby the content and value of the article were accepted, but the reader reserved the privilege of not being bound by the results because of technical, sponsorship, or methodological issues that "might be present." The quality of photographs was accepted as a proxy for the quality of technical work performed. CONCLUSIONS: Dentists actively customized the reading of a journal article that described a technical procedure. They imposed a non-linear structure for absorbing information and a standard of personal relevance, and, while accepting the results, created reasons for not necessarily having to accept them as applicable. The approach clinicians use in reading a procedural article may be different from the structure writers use in preparing a paper.

Evaluación del procesamiento de muestras con equipos de alta tecnología en estudiantes de bioanálisis clínico / Evaluation of samples procedures with high-technology equipments by students of clinical bioanalysis

Se realizó un estudio descriptivo y transversal de los 76 estudiantes del cuarto año de la carrera de bioanálisis clínico en la Facultad de Tecnología de la Salud "Dr. Juan Manuel Páez Inchausti" de Santiago de Cuba, desde septiembre del 2012 hasta enero del 2013, con vistas a evaluar las habilidades prácticas de estos en el procesamiento de muestras con equipos de alta tecnología. El empleo de métodos teóricos y empíricos propios de la investigación pedagógica, reveló insuficiencias en las habilidades prácticas relacionadas con la calibración y manipulación de los equipos, debido a la influencia de diferentes factores. Asimismo, se constató la necesidad de emplear medios alternativos de enseñanza que propicien las vías de solución para dicho problema, y que a su vez sean utilizados como material de consulta, preparación y autoevaluación de los educandos.

A descriptive and cross sectional study of the 76 students of the fourth year of the clinical bioanalysis career in "Dr. Juan Manuel Páez Inchausti" Health Technology Faculty, Santiago de Cubawas carried out from September, 2012 to January, 2013, aimed at evaluating their practical skills in the processing of samples with high-technology equipments. The use of theoretical and empiric methods characteristic of the pedagogic investigation, revealed deficiencies in the practical skills related to the calibration and manipulation of the equipments, due to the influence of different factors. Also, the necessity of using teaching alternative means giving solution to this problem was verified, and that, in turn, could be used as consulting, preparation and self-assessment material for the students.

Reconstrucción de un defecto vulvar crónico secundario al tratamiento de un carcinoma primario de la vagina: reporte de un caso y consideraciones de manejo / Reconstruction of a chronic secondary vulvar defect upon treatment of primary vaginal carcinoma: a case report and management considerations

El cáncer de vagina es una neoplasia rara, que constituye un 1% del cáncer genital femenino, aunque ha aumentado su incidencia en los últimos años. El manejo quirúrgico, adyuvante y reconstructivo resulta importante en el resultado oncológico y funcional de la enfermedad, pero puede comprometer la anatomía y función vaginal, y la de los órganos adyacentes. El avance en las terapias quirúrgicas y adyuvantes en pacientes más jóvenes ha conducido a una mayor supervivencia, implicando la necesidad de un mejor manejo del defecto anatómico de la lesión o de las secuelas de su tratamiento. Debe intentarse siempre que sea necesario un manejo multidisciplinario, desde la primera intervención, incluyendo la técnica reconstructiva correspondiente al defecto. Se presenta un caso de manejo conjunto oncológico y reconstructivo, mediante colgajo unilateral en flor de loto de un defecto vulvar crónico, originado tras el manejo de un cáncer vaginal primario previo.

Vaginal cancer is a rare neoplasm which makes up 1% of female genital cancer; however, its incidence has risen in the past few years. Adjuvant and reconstructive surgical management prove to be important in the oncologic and functional outcome of the disease, but may involve anatomy and function in the vagina, as well as in adjacent organs. Breakthroughs in surgical and adjuvant therapy have led to greater survival rates among younger patients, thus implying a greater need for improved management of the anatomical defect in the lesion or of treatment side effects. An effort should always be made towards interdisciplinary management, from the initial interven tion, including the corresponding reconstructive technique used on the defect. A case is presented on the combined oncologic and reconstructive management achieved by means of a lotus flower unilateral flap for a chronic vulvar defect brought about by previous primary vaginal cancer.