Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries.

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.

Application of telemedicine in the COVID-19 epidemic: An analysis of Gansu Province in China.

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.

Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census.

OBJECTIVE: To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS: Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS: QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION: QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.

Does ATLS Training Work? 10-Year Follow-Up of ATLS India Program.

BACKGROUND: Studies evaluating the efficacy of ATLS in low- and middle-income countries are limited. We followed up ATLS providers certified by the ATLS India program over a decade (2009 to 2019), aiming to measure the benefits in knowledge, skills, attitude and their attrition over time. METHODS: The survey instrument was developed taking a cue from published literature on ATLS and improvised using the Delphi method. Randomly selected ATLS providers were sent the survey instrument via email as a Google form, along with a statement of purpose. Results are presented descriptively. RESULTS: ATLS India trained 7,847 providers over the study period. 2500 providers were selected for the survery using computer-generated random number table. One thousand and thirty doctors (41.2%) responded. Improvement in knowledge (n = 1,013 [98.3%]), psychomotor skills (n = 986 [95.7%]), organizational skills (n = 998 [96.9%]), overall trauma management (n = 1,013 [98.7%]) and self-confidence (n = 939 [91%]) were reported. Majority (904 [87.8%]) started ATLS promulgation at workplace in personal capacity. These benefits lasted beyond 2 years in majority (>60%) of respondents. More than 40% reported cognitive (n = 492 [47.8%]), psychomotor (n = 433 [42%]), and organizational benefits (n = 499 [48.4%]) lasting beyond 3 years. Improvement in self-confidence, ATLS promulgation at the workplace, and retention of organizational skills were more pronounced in ATLS faculties than providers. All other benefits were found to be comparable in both sub-groups. Lack of trained staff (n = 660 [64.1%]) and attitude issues (n = 495 [48.1%]) were the major impediments in implementing ATLS at the workplace. More than a third of respondents (n = 373 [36.2%]) could enumerate one or more incidents where ATLS principles were life- or limb- saving. CONCLUSIONS: Cognitive, psychomotor, organizational, and affective impact of ATLS is overwhelmingly positive in the Indian scenario. Until formal trauma systems are established, ATLS remains the best hope for critically injured patients in resource-contrained settings.

Decentralizing PrEP delivery: Implementation and dissemination strategies to increase PrEP uptake among MSM in Toronto, Canada.

Pre-exposure prophylaxis (PrEP) is traditionally prescribed by HIV specialist physicians. Given finite specialist resources, there is a need to scale up PrEP delivery by decentralizing services via other healthcare professionals. We aimed to assess the feasibility of delivering PrEP to men who have sex with men (MSM) through primary care physicians and sexual health clinic nurses. We piloted a multi-component, implementation and dissemination research program to increase provision of PrEP through primary care physicians and sexual health clinic nurses in Toronto, Canada. Community-based organizations (CBOs) provided prospective participants with information cards that contained links to an online module on engaging providers in a conversation about PrEP. In our patient-initiated continuing medical education (PICME) strategy, participants saw their family doctors and gave them the card, which also contained a link to a Continuing Medical Education module. In the nurse-led strategy, participants visited one of two participating clinics to obtain PrEP. We administered an optional online questionnaire to patients and providers at baseline and six months. CBOs distributed 3043 cards. At least 339 men accessed the online module and 196 completed baseline questionnaires. Most (55%) intended to visit nurses while 21% intended to consult their physicians. Among 45 men completing follow-up questionnaires at 6 months, 31% reported bringing cards to their physicians and obtaining PrEP through them; sexual health clinics delivered PrEP to 244 patients. Participants who went through the PICME approach reported no changes in relationships with their providers. Nurses showed fidelity to PrEP prescribing guidelines. Nurse-led PrEP and patient-initiated continuing medical education (PICME) for primary care physicians are feasible strategies to increase PrEP uptake. Nurse-led PrEP delivery was preferred by most patients.

What Influences Choice of Continuing Medical Education Modalities and Providers? A National Survey of U.S. Physicians, Nurse Practitioners, and Physician Assistants.

PURPOSE: To explore what influences clinicians in selecting continuing medical education (CME) activities in the United States. METHOD: In August 2018, the authors conducted an Internet-based national survey, sampling 100 respondents from each of 5 groups: family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants. In total, 1,895 clinicians were invited and 500 (26%) responded. Questions addressed the selection and anticipated use of CME delivery modalities and perceived characteristics of specific CME providers. Response formats used best-worst scaling or 5-point ordinal response options. RESULTS: The factors identified as most important in selecting CME activities were topic (best-worst scaling net positivity 0.54), quality of content (0.51), availability of CME credit (0.43), and clinical practice focus (0.41), while referral frequency (-0.57) ranked lowest. The activities that the respondents anticipated using most in the future were live (mean 3.8 [1 = not likely, 5 = very likely]), online (mean 3.5), point-of-care (mean 3.5), and print-based (mean 3.5) activities. For online CME, the features of greatest appeal were that learning could be done when clinicians had time (mean 4.4), at their own pace (mean 4.2), and at lower cost (mean 4.2). For live CME, the features of greatest appeal were that the subject was best taught using this modality (mean 4.0), or the activity was located in a destination spot (mean 4.0) or a regional location (mean 3.9). When rating specific CME providers, most academic institutions received relatively high ratings for research focus and clinical practice focus, whereas commercial providers had slightly higher ratings for ease of access. Responses were generally similar across clinician types and age groups. CONCLUSIONS: Physicians, nurse practitioners, and physician assistants are interested in using a variety of CME delivery modalities. Appealing features of online and live CME were different.

Pediatric Orthopaedic Observerships in North America for International Surgeons: The Visitor's Perspective.

BACKGROUND: There is substantial disparity in access to surgical care worldwide that largely impacts children in resource-limited environments. Although it has been suggested that surgeons in high-income countries work alongside their overseas peers to bridge this gap, there is limited information regarding the impact of pediatric orthopaedic observerships that are available to international surgeons. This study aimed to assess the perceived impact of such visitations on overseas surgeons, including their professional development and clinical practice. METHODS: A survey was distributed to overseas surgeons who participated in a pediatric orthopaedic observership in North America in the years 2009 to 2019. Details were collected regarding each respondent's demographics and observership program, and the impact of this short-term clinical experience as perceived by the visiting surgeon. RESULTS: Of the 181 international surgeons from 56 countries who participated in a pediatric orthopaedic observership, most were young male surgeons residing in a middle-income nation. The majority of surgeons observed in outpatient clinics (98%) and in the operating room (96%) and attended educational in-house conferences (92%). Most observers (75%) acknowledged gaining relevant orthopaedic knowledge and clinical skills that improved local patient care, and nearly all (99%) shared the newly acquired knowledge with their peers and trainees. Most (97%) were still living and working in the country that had been their residence at the time of their observership. No noteworthy trends were identified between the income classification of the surgeons' country of residence and their ability to incorporate the acquired skills into their practice. CONCLUSIONS: Participating in a North American pediatric orthopaedic observership has a positive perceived impact on the majority of visiting surgeons, with potential gains in clinical skills and knowledge that likely benefit their patients, peers, and trainees. Such participation does not contribute to substantial brain drain and may assist with local capacity building. Identifying ways to increase access to such educational opportunities, particularly for surgeons from lower-income countries, should be explored further.

Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review.

INTRODUCTION: Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research. METHODS: A scoping review was used to "map" the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities. RESULTS: Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles. DISCUSSION: Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.

Current Practices and Existing Gaps of Continuing Medical Education among Resident Physicians in Abha City, Saudi Arabia.

BACKGROUND: Continuing medical education (CME) is an everlasting process throughout the physician's working life. It helps to deliver better services for the patients. OBJECTIVES: To explore CME among resident physicians in Abha City; their current practices, their opinions, and barriers faced. METHODS: A cross-sectional study was conducted among resident physicians at the Ministry of Health hospitals in Abha City using a validated self-administered questionnaire. It included personal characteristics, current CME practices, satisfaction with CME, and barriers to attendance. RESULTS: The present study included 300 residents from 15 training specialties. Their reported CME activities during the previous year were lectures and seminars (79.7%) followed by conferences (43.7%), case presentations (39.7%), workshops (34.0%), group discussion (29/7%), and journal clubs (27.3%). Astonishingly enough, very few (8%) attended online electronic CME activities. There were significant differences in CME satisfaction scores by different training specialties. Regarding residents' perceptions of the effectiveness of different CME activities (conferences/symposia, workshops/courses, and interdepartmental activities) the results showed that workshops and courses were significantly the most effective method compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in improving practice behaviors. Barriers reported were being busy, lack of interest, high cost, and lack of suitable providers. CONCLUSION: Based on the findings of this study, it is recommended that online learning be promoted as a CME format for trainees. There should be support of residents and clinicians through the provision of protected time for their CME activities outside their daily clinical commitments.

Characteristics among six generations of medicine graduates.

BACKGROUND: Medical graduates follow-up programs allow the improvement of the curriculum of the Medicine career. Through identifying opportunity areas and strengthening points, institutions become increasingly competitive. OBJECTIVE: Identify the socio-demographic, formative, labor insertion and satisfaction characteristics among six generations of graduates of the Medical School of the Faculty of Medicine of the National Autonomous University of Mexico (2004-2009). METHOD: It is a descriptive, cross-sectional, retrospective, comparative study integrating the answers of mailed electronic questionnaires to 5295 graduates who concluded studies between 2004 and 2009. Descriptive and inferential techniques were used for analysis. RESULTS: An upward trend in the number of years to conclude the career was identified and an increase in failed assignments in the last three generations. Noticeable was also that, as time went by, the incorporation of physicians into the labor market was slower. Although the percentage of general unemployment was very low (2.9%). CONCLUSIONS: There are no major changes in the characteristics of the Medicine graduates. Although it is necessary to identify the reason for the increased in failed assignments which affects the length of completion. Further improvement in Research and Social Medicine programs are to be considered.

ANTECEDENTES: Los programas de seguimiento de egresados permiten mejorar los programas y el currículo de la carrera de Medicina, identificando las áreas de oportunidad y haciendo más competitivas a las instituciones educativas. OBJETIVO: Identificar las características sociodemográficas, formativas, de inserción laboral y de satisfacción, en seis generaciones de egresados de la carrera de Medicina de la Universidad Nacional Autónoma de México (2004-2009). MÉTODO: Estudio descriptivo, transversal, retrospectivo y comparativo, con 5295 egresados de la carrera de Medicina que concluyeron entre 2004 y 2009. Se envió un cuestionario por correo electrónico a cada uno de los egresados y se analizaron los resultados mediante técnicas descriptivas e inferenciales. RESULTADOS: Se observó un incremento en el número de años para concluir la carrera y un aumento en el número de materias reprobadas en las últimas tres generaciones. Además, hubo mayor lentitud en la inserción laboral en el mismo periodo, aunque el porcentaje de desempleo general fue muy bajo (2.9%). CONCLUSIONES: No hay cambios en la caracterización de los egresados respecto a generaciones anteriores; no obstante, será fundamental identificar las causas del incremento en el número de materias reprobadas que está afectando la eficiencia terminal, además de mejorar los programas de investigación epidemiológica y socio-médica.

Prospective Evaluation of the Accuracy of A Training Program in Image Recognition by Narrow-Band Imaging Guided Hysteroscopy of Endometrial Neoplasms.

INTRODUCTION: Narrow-band imaging (NBI) hysteroscopy by experienced hysteroscopists (EH) is useful for diagnosing endometrial neoplasms. OBJECTIVE: We investigated whether the diagnostic reliability of NBI could be improved by specific professional training. METHODS: Three levels of trainees who were Surgeons at our hospital were selected. Level I: 6 trainees had no prior hysteroscopic experience; level II: 6 trainees had experience with <100 cases; and level III: 6 trainees had <500 cases. The two-hour training program for white light hysteroscopy (WLH) and NBI included information on the classifications of diseases of the uterine cavity and on the features of diagnostic images. Images from 529 patients were evaluated independently by trainees with 3 levels of before and after training, and by EH. Trainees and EHs had to analyze and arrive at a hysteroscopic diagnosis for each image that was compared to the pathological diagnosis for diagnostic accuracy. RESULTS: After training, all levels achieved higher diagnostic accuracy with NBI than was seen with WLH. Level III trainees achieved diagnostic accuracy and kappa values for NBI that were equivalent to those of EH. CONCLUSIONS: Training can increase the diagnostic skill of all trainees using NBI, especially for trainees with prior hysteroscopic experience.

Educational impact of the mini-Clinical Evaluation Exercise in resident standardization training: a comparative study between resident and professional degree postgraduate trainees.

OBJECTIVE: We aimed to explore differences in the educational impact of the mini-Clinical Evaluation Exercise (mini-CEX) on resident (RE) and professional degree postgraduate (PDPG) trainees, as well as influencing factors, to provide suggestions for hospital managers, trainers, and trainees. METHODS: We performed a retrospective analysis of all scores among first-year resident standardization training trainees registered during 2017 to 2019 at Xinqiao Hospital of Army Medical University, to identify differences in mini-CEX outcomes between REs and PDPGs. RESULTS: We collected data of 154 registered trainees for retrospective analysis, including 57 PDPG trainees and 97 RE trainees. The mean (standard deviation) overall performance score of PDPGs was 84.18 (4.25), which was higher than that of REs (81.48 (3.35)). In terms of domain analysis, PDPG trainees performed significantly better than REs in history taking, physical examination, clinical diagnosis/treatment regimen, and the knowledge examination; communication skills/humanistic care were comparable between the groups. CONCLUSIONS: PDPGs performed better than REs in overall competency, history taking, physical examination, clinical diagnosis/treatment regimen, and the knowledge examination. A better knowledge base, supervisor-dominated one-to-one teaching mode, higher self-esteem and learning goals, and more sophisticated responses to feedback were potential contributors to a superior educational impact of the mini-CEX.

Adaptation and validation of the Argentine version of an instrument to assess continuing professional development activities. / Adaptación y validación de la versión argentina de un instrumento para evaluar actividades de desarrollo profesional continuo.

INTRODUCTION: Canadian researchers developed a self-administered questionnaire to ask participants of continuing professional development (CPD) activities about their intention to translate the knowledge acquired in the classroom into clinical practice. The questionnaire may facilitate quality improvement processes in such CPD activities. OBJECTIVE: To translate, cross-culturally adapt and validate the original English REACTION questionnaire (A theoRy-basEd instrument to assess the impACT of continuing professional development activities on professional behavIOr chaNge) for its use in Argentina. POPULATION AND METHODS: The 12 questionnaire items were translated and cross-culturally adapted using a five-step process. The construct validity was assessed using an exploratory factor analysis, whereas reliability, with Cronbach's coefficient and the G coefficient. RESULTS: The final questionnaire version was administered to a sample of 133 physicians who attended 9 CPD activities at a teaching hospital in the Autonomous City of Buenos Aires (average age: 38 years; 23.3 %, men; 76 %, family physicians). The exploratory factor analysis showed 3 factors (social influence, confidence in one's abilities, and ethical judgment). Cronbach's coefficient was 0.82 and the G coefficient, 0.72. CONCLUSIONS: The Argentine version of the REACTION questionnaire was adapted and validated to assess the impact of CPD centered on clinical skills training on physicians' intention to implement it in their practice.

Introducción. Investigadores canadienses desarrollaron un cuestionario autoadministrado para indagar sobre la intención de los participantes de actividades de desarrollo profesional continuo (DPC) de transferir los conocimientos adquiridos en ámbitos áulicos a la práctica clínica. Su uso podría facilitar los procesos de mejora de la calidad en dichas actividades de DPC. Objetivo. Realizar la traducción y adaptación transcultural y validación del cuestionario REACTION (A theoRy-basEd instrument to assess the impACT of continuing profesional development activities on profesional behavIOr chaNge) para su uso en la Argentina, a partir de la versión original en inglés. Población y métodos. Se realizó la traducción y adaptación transcultural de los 12 ítems del instrumento, con un proceso de cinco pasos. La validez de constructo se exploró mediante el análisis factorial exploratorio, y la confiabilidad, a través del coeficiente de Cronbach y el coeficiente G. Resultados. La versión final del cuestionario se aplicó a una muestra de 133 médicos asistentes a 9 actividades presenciales de DPC de un hospital universitario de la Ciudad de Buenos Aires (edad promedio: 38 años; el 23,3 %, hombres; el 76 %, médicos de familia). El análisis factorial exploratorio arrojó 3 factores (influencia social, confianza en las capacidades propias y criterio ético). El coeficiente de Cronbach fue 0,82 y el coeficiente G fue 0,72. Conclusiones. Se realizó la adaptación y validación de la versión argentina del instrumento REACTION para evaluar el impacto del DPC enfocado en el entrenamiento de habilidades clínicas en la intención de los médicos de implementarlo en su práctica.

Development and assessment of competency-based neurotrauma course curriculum for international neurosurgery residents and neurosurgeons.

OBJECTIVE: Traumatic brain injuries (TBIs) are a significant disease burden worldwide. It is imperative to improve neurosurgeons' training during and after their medical residency with appropriate neurotrauma competencies. Unfortunately, the development of these competencies during neurosurgeons' careers and in daily practice is very heterogeneous. This article aimed to describe the development and evaluation of a competency-based international course curriculum designed to address a broad spectrum of needs for taking care of patients with neurotrauma with basic and advanced interventions in different scenarios around the world. METHODS: A committee of 5 academic neurosurgeons was involved in the task of building this course curriculum. The process started with the identification of the problems to be addressed and the subsequent performance needed. After this, competencies were defined. In the final phase, educational activities were designed to achieve the intended learning outcomes. In the end, the entire process resulted in competency and outcomes-based education strategy, including a definition of all learning activities and learning outcomes (curriculum), that can be integrated with a faculty development process, including training. Further development was completed by 4 additional academic neurosurgeons supported by a curriculum developer specialist and a project manager. After the development of the course curriculum, template programs were developed with core and optional content defined for implementation and evaluation. RESULTS: The content of the course curriculum is divided into essentials and advanced concepts and interventions in neurotrauma care. A mixed sample of 1583 neurosurgeons and neurosurgery residents attending 36 continuing medical education activities in 30 different cities around the world evaluated the course. The average satisfaction was 97%. The average usefulness score was 4.2, according to the Likert scale. CONCLUSIONS: An international competency-based course curriculum is an option for creating a well-accepted neurotrauma educational process designed to address a broad spectrum of needs that a neurotrauma practitioner faces during the basic and advanced care of patients in different regions of the world. This process may also be applied to other areas of the neurosurgical knowledge spectrum. Moreover, this process allows worldwide standardization of knowledge requirements and competencies, such that training may be better benchmarked between countries regardless of their income level.

'Think Hep B' in primary care: A before-and-after evaluation of a self-guided learning package.

BACKGROUND AND OBJECTIVES: In Australia, over a third of individuals living with chronic hepatitis B (CHB) remain undiagnosed. Evidence suggests general practitioners (GPs) can be uncertain regarding whom to test. The aim of this study was to evaluate an educational resource for improving GPs' knowledge about whom to test for CHB. METHOD: Following a 2014 baseline survey that identified gaps in CHB knowledge among GPs in Victoria, an educational resource package was developed. Using a follow-up survey, the resource was evaluated by comparing the before-and-after CHB-related knowledge. RESULTS: Sixty-five GPs responded to both the baseline and follow-up survey. Their knowledge of populations at high risk of CHB who require testing was significantly greater following the intervention than at baseline. DISCUSSION: Concise, clear and practical resources can support GPs when identifying whom to test for hepatitis B.

Telementoring in Leg Fasciotomies via Mixed-Reality: Clinical Evaluation of the STAR Platform.

INTRODUCTION: Point-of-injury (POI) care requires immediate specialized assistance but delays and expertise lapses can lead to complications. In such scenarios, telementoring can benefit health practitioners by transmitting guidance from remote specialists. However, current telementoring systems are not appropriate for POI care. This article clinically evaluates our System for Telementoring with Augmented Reality (STAR), a novel telementoring system based on an augmented reality head-mounted display. The system is portable, self-contained, and displays virtual surgical guidance onto the operating field. These capabilities can facilitate telementoring in POI scenarios while mitigating limitations of conventional telementoring systems. METHODS: Twenty participants performed leg fasciotomies on cadaveric specimens under either one of two experimental conditions: telementoring using STAR; or without telementoring but reviewing the procedure beforehand. An expert surgeon evaluated the participants' performance in terms of completion time, number of errors, and procedure-related scores. Additional metrics included a self-reported confidence score and postexperiment questionnaires. RESULTS: STAR effectively delivered surgical guidance to nonspecialist health practitioners: participants using STAR performed fewer errors and obtained higher procedure-related scores. CONCLUSIONS: This work validates STAR as a viable surgical telementoring platform, which could be further explored to aid in scenarios where life-saving care must be delivered in a prehospital setting.

Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice.

STUDY OBJECTIVE: To assess surgical outcomes, clinical effectiveness, and gynecologist experience of introducing laparoscopic radiofrequency ablation (RFA) of leiomyomas into surgical practice. DESIGN: Uncontrolled clinical trial. SETTING: Five academic medical centers across California. PATIENTS: Premenopausal women with symptomatic uterine leiomyomas, uterus size ≤16 weeks size, and all leiomyomas ≤10 cm with no more than 6 total leiomyomas. INTERVENTIONS: Laparoscopic RFA of leiomyomas. MEASUREMENTS AND MAIN RESULTS: We assessed intraoperative complications, blood loss, operative time, and adverse events. Gynecologists reported the operative difficulty and need for further training after each case. Participants reported leiomyoma symptoms preoperatively and at 6 and 12 weeks after surgery. We analyzed all outcome data from the first case performed by gynecologists with no previous RFA experience. Patient demand for RFA was high, but poor insurance authorization prevented 74% of eligible women from trial participation; 26 women underwent surgery and were enrolled. The mean age of the participants was 41.5 ± 4.9 years. The mean operating time was 153 ± 51 minutes, and mean estimated blood loss was 24 ± 40 cc. There were no intraoperative complications and no major adverse events. Menstrual bleeding, sexual function, and quality of life symptoms improved significantly from baseline to 12 weeks, with a 25 ± 18-point, or 47%, decrease in the Leiomyoma Symptom Severity Score. After the first procedure, the mean difficulty score was 6 (95% confidence interval [CI], 4-7.5) on a 10-point scale, and 89% of surgeons felt "very or somewhat" confident in performing laparoscopic RFA. The difficulty score decreased to 4.25 (95% CI, 1.2-6) after the fourth procedure, with all gynecologists reporting surgical confidence. CONCLUSION: Laparoscopic RFA of leiomyomas can be introduced into surgical practice with good clinical outcomes for patients. Gynecologists with no previous experience are able to gain confidence and skill with the procedure in fewer than 5 cases.

What are the current 'top five' perceived educational needs of Irish general practitioners?

INTRODUCTION: Doctors' continuing medical educational and professional development (CME and CPD) needs are known to be strongly influenced by national and local contextual characteristics. A crucial step in the development of effective education and training programmes is the assessment of learner needs. METHODS: A national needs assessment was conducted among general practitioners (GPs) in the Republic of Ireland who attended continuing medical education small group learning meetings (CME-SGL) in late 2017. Doctors completed a self-administered anonymous three-page questionnaire which gathered demographic data and asked them to choose their 'top five' perceived educational needs from separate lists of topics for CME and CPD. RESULTS: There were 1669 responses (98% of monthly attendance). The topics most commonly identified as a priority for further CME were prescribing (updates/therapeutics), elderly medicine, management of common chronic conditions, dermatology, and patient safety/medical error. The most commonly selected CPD topics were applying evidence-based guidelines to practice, appraising performance/conducting practice audits, coping with change, and managing risk and legal medicine. There was no difference between urban and rural practice settings regarding the most commonly chosen topics in each category; however, more rural GPs selected pre-hospital/emergency care as one of their 'top five'. CONCLUSION: Our findings identified priority areas where CME and CPD for GPs in Ireland should focus. The topics selected may reflect the changing nature of general practice, which increasingly requires delivery of care to an ageing population with more multi-morbidity and chronic disease management, while trying to apply evidence-based medicine and consider patient safety issues. CME/CPD programmes need to adapt accordingly.