Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial.

PURPOSE: To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). METHODS: This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance. RESULTS: Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging. CONCLUSION: While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.

Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia.

PURPOSE: The purpose of this report was to analyze data collected in an outcomes study in an attempt to identify factors that may be significant predictors of either patient satisfaction or dissatisfaction with deep sedation/general anesthesia (DS/GA) administered in an office-based setting. MATERIALS AND METHODS: To address the research purpose, we used a prospective cohort study design and sample of patients undergoing procedures in the office-based ambulatory setting of oral and maxillofacial surgeons practicing in the United States who received local anesthesia (LA), conscious sedation (CS), or DS/GA. The predictor variables were categorized as demographic, anesthetic technique, adverse events, and patient-oriented outcomes (satisfaction/dissatisfaction). Appropriate descriptive and exact P values were completed as indicated. Statistical significance was set at P < .05. Multivariate analyses were performed to support the interpretation of univariate findings. RESULTS: The sample was composed of 34,191 patients, of whom 71.9% patients received DS/GA. There were 20,455 patient satisfaction forms completed, of which 14,912 forms were from patients undergoing DS/GA. Of patients who received DS/GA, 95.8% were extremely or moderately satisfied, 3.1% were neutral, and 1.1% moderately or extremely dissatisfied. Increased age and memory of postoperative instructions were identified as factors, which predicted satisfaction. The addition of nitrous oxide to some regimens also appeared to increase satisfaction. Young age, anxiety, pain, vomiting, and being awake during the procedure were predictors of dissatisfaction. CONCLUSIONS: The findings of this study indicate that patients are overwhelmingly satisfied with DS/GA provided in an office-based ambulatory setting. Items identified as significant predictors of dissatisfaction (anxiety, pain, vomiting, being awake) generally confirm preexistent suppositions. Surprisingly, patient age (<10 years old) and memory of postoperative instructions appear to have relevance to dissatisfaction as well. Lack of specific regimens and controls prevents confirmation that nitrous oxide improves patient satisfaction rates. Although statistically significant, the variations, which resulted in a higher or lower satisfaction rate, are of questionable clinical significance in many cases.

Biomechanical tissue characterization of the superior joint space of the porcine temporomandibular joint.

The objective of this study was to characterize the biomechanical properties of articular cartilage in the superior joint space of the porcine temporomadibular joint (TMJ). These properties and thickness of the disk and fossa cartilage were obtained from eight joints using creep indentation. Five sites per surface were tested to obtain the aggregate modulus, Poisson's ratio, permeability, creep, recovery percentage, and cartilage thickness. Histology was also performed to characterize the orientation of the collagen fibers and the proteoglycan content. It was found that the temporal fossa cartilage was 57% thinner and 50% stiffer than the disk. The aggregate modulus of the porcine TMJ disk and fossa was much smaller, but the permeability of the TMJ disk and fossa was much higher than those of articular cartilage in other joints. It was also noted that the TMJ disk did not fully recover following indentation testing unlike the articular cartilage in other joints. The biomechanical properties of the TMJ disk and temporal fossa obtained in this study are significantly different from those of cartilage present in other diarthrodial joints. This suggests that the function of the fibrocartilage in the superior TMJ space is substantially different from that of hyaline cartilage in other joints.