Use of gelatin puzzle phantoms to teach medical students isolated ultrasound transducer movements and fundamental concepts.

BACKGROUND: Psychomotor skills related to the use of medical ultrasound are a fundamental, but often overlooked component of this ubiquitous medical imaging technology. Although discussions of image production/orientation, sonographic planes, and imaging/scanning techniques are common in existing literature, these discussions rarely address practical skills related to these basic concepts. The cognitive load of transducer movements and machine operation, in conjunction with learning the ultrasound representation of anatomy, may overwhelm a novice learner. Our goal was to develop and evaluate a set of ultrasound puzzle phantoms for students to use as they learn isolated, specific transducer movements and sonographic concepts. We intentionally created phantoms that contain objects that are likely familiar to students to reduce the cognitive load associated with simultaneously learning the ultrasound interpretation of anatomy. METHODS: This preliminary evaluation of our novel, homemade, gelatin ultrasound puzzle phantoms was performed using pretests and posttests obtained by scanning an assessment phantom, and student questionnaires. Two phases of training and testing occurred with feedback from Phase 1 allowing for refinement of the puzzles and techniques for testing. Skills taught and evaluated included probe rotation, depth assessment, sliding, and tilting. RESULTS: Twenty-eight students attended the Phase 1 training session with positive trends in students' abilities to use rotation, sliding, and tilting to answer questions, while only depth showed statistically significant improvements (p = 0.021). Overall students agreed the experience a productive use of time (86%), was beneficial (93%), and would recommend to others (93%). Fifteen (54%) students returned 3 months later. There was no significant decay in skills obtained from the prior training session. In Phase 2, 134 medical students participated, and 76 (57%) completed an online questionnaire. A majority of students agreed they had a better understanding of rotation (83%), depth (80%), sliding (88%) and tilting (55%). Similar to Phase 1, many students (75%) felt the experience was beneficial. CONCLUSIONS: This preliminary study gave us insight into student opinions, as well as information to guide future scalability and development of additional ultrasound puzzle phantoms to aid in medical student education of isolated transducer movements and sonographic concepts prior to imaging human anatomy.

Human Factors Results for Fentanyl Iontophoretic Transdermal System (ITS) With Enhanced Controller for Postoperative Pain Management.

PURPOSE: The purpose of this analysis was to conduct summative usability evaluations, including behavioral and subjective evaluations, for the fentanyl iontophoretic transdermal system (ITS). DESIGN: Four usability studies were conducted in representative users. METHODS: The first three studies were conducted with (1) health care professionals (HCPs; N = 31), (2) patients who received placebo fentanyl ITS (N = 30), and (3) healthy volunteers (N = 30), and focused on the understanding and use of fentanyl ITS. The fourth study included HCPs (N = 31) and healthy volunteers (N = 30), and focused on the effectiveness of formal training regarding the use of fentanyl ITS. FINDINGS: Overall, user groups found the fentanyl ITS easy to use. There were no use errors that could potentially have safety implications. In the three early studies, there were some minor difficulties experienced; however, the introduction of a structured training reduced these difficulties. CONCLUSIONS: Patients, nurses, and pharmacists were able to use fentanyl ITS with ease.

Learning the Language of Medical Device Innovation: A Longitudinal Interdisciplinary Elective for Medical Students.

PROBLEM: Physicians are playing a growing role as clinician-innovators. Academic physicians are well positioned to contribute to the medical device innovation process, yet few medical school curricula provide students opportunities to learn the conceptual framework for clinical needs finding, needs screening, concept generation and iterative prototyping, and intellectual property management. This framework supports innovation and encourages the development of valuable interdisciplinary communication skills and collaborative learning strategies. APPROACH: Our university offers a novel 3-year-long medical student Longitudinal Interdisciplinary Elective in Biodesign (MSLIEB) that teaches medical device innovation in 4 stages: (1) seminars and small-group work, (2) shared clinical experiences for needs finding, (3) concept generation and product development by serving as consultants for biomedical engineering capstone projects, and (4) reflection and mentorship. The MSLIEB objectives are to: create a longitudinal interdisciplinary peer mentorship relationship between undergraduate biomedical engineering students and medical students, and encourage codevelopment of professional identities in relation to medical device innovation. OUTCOMES: The MSLIEB enrolled 5 entering cohorts from 2017 to 2021 with a total of 37 medical student participants. The first full entering cohort of 12 medical students produced 8 mentored biomedical engineering capstone projects, 7 of which were based on clinical needs statements derived from earlier in the elective. Medical student participants have coauthored poster and oral presentations; contributed to projects that won WolfieTank, a university-wide competition modeled after the television show Shark Tank; and participated in the filing of provisional patents. Students reflecting on the course reported a change in their attitude towards existing medical problems, felt better-equipped to collaboratively design solutions for clinical needs, and considered a potential career path in device design. NEXT STEPS: The MSLIEB will be scaled up by recruiting additional faculty, broadening clinical opportunities to include the outpatient setting, and increasing medical student access to rapid prototyping equipment.

Levorphanol in the Perioperative Setting: Decreasing Opioid Requirements While Improving Pain Management.

Levorphanol is a Food and Drug Administration (FDA)-approved long-acting opioid. Most information on perioperative use of levorphanol comes from the early- and mid-1950s when this drug emerged in the field of experimental pharmacology and anesthesia. It was mainly studied during this period with some additional data being generated in the 1960s and 70s. Since this time, perioperative use has declined and research is limited. This review of literature aims to provide pharmacologic and historic description of levorphanol as a tool for perioperative pain management and as an aid to potentially decrease total postoperative opioid use during the current opioid crisis.

A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber.

The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient's body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.

Randomized trial of acupressure to improve patient satisfaction and quality of recovery in hospitalized patients: study protocol for a randomized controlled trial.

BACKGROUND: Acupressure therapy may be potentially beneficial in improving postoperative symptoms like postoperative nausea and vomiting (PONV), pain and sleep disorder and improving postoperative quality of recovery. The primary aim of this study is to investigate the efficacy of acupressure therapy on postoperative patient satisfaction and quality of recovery in hospitalized patients after surgical treatment. METHODS/DESIGN: This three-group, parallel, superiority, blinded, randomized controlled trial will test the hypothesis that a combination of PC6, LI4 and HT7 acupressure is superior to sham or no intervention for improving postoperative quality of recovery in hospitalized patients. A minimum of 150 patients will be randomly allocated to one of the three experimental groups: control (no visit), light touch (sham acupressure) or active acupressure therapy in a 1:1:1 ratio. Interventions will be performed three times a day for 2 days. Patient satisfaction, quality of recovery, PONV and pain will be measured during the 3 days following randomization. The study protocol was approved by the Stony Brook University Institutional Review Board on 21 March 2016. Written informed consent will be recorded from every consented patient. DISCUSSION: This study has the potential to improve the recovery of hospitalized patients by adding knowledge on the efficacy of acupressure therapy in this setting. A multipoint acupressure protocol will be compared to both a no intervention group and a light touch group, providing insight into different aspects of the placebo effect. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02762435 . Registered on 14 April 2016.