Utilizing Competence-Based Simulation to Improve Orientation Outcomes.

BACKGROUND: New graduate respiratory therapists (RTs), regardless of the degree program, receive limited preparation in neonatal/pediatric diseases and management. Experienced RTs typically have adult knowledge but limited exposure to pediatrics. We developed a program that included competence-based simulation to improve orientation success. METHODS: A 9-week orientation program curriculum with simulation-based competence assessment was developed to ensure all new hires gained knowledge and skills to perform pediatric clinical tasks. Each new hire individually completed the same simulation scenarios during the first week and last week of orientation. Curriculum changes were made over time based on performance in simulations and on-the-job knowledge and skills during and after orientation. Paired and unpaired t tests were used with P < .05 as significant. RESULTS: From January 2017-February 2020, the program had 3 updates. Noninvasive ventilation and decompensating patient scenarios were completed for all periods. Ninety-two new staff were oriented in period 1 = 29 (new graduate RTs 20, experienced RTs 9); period 2 = 17 (new graduate RTs 10, experienced RTs 7); period 3 = 24 (new graduate RTs 21, experienced RTs 3), and period 4 = 22 (new graduate RTs = 22). Remediation during orientation occurred in 15% of the staff. Seventy-one percent successfully advanced to ICU orientation after completion of the program. All staff improved scores between pre- versus post-simulations in all periods: mean difference ± SD period 1: new graduate RTs 32.0 ± 17.0, P < .001; experienced RTs 28.0 ± 18.9, P < .001; period 2: new graduate RTs 23.0 ± 15.2, P < .001; experienced RTs 29.0 ± 12.1, P < .001; period 3: new graduate RTs 26.0 ± 15.8, P < .001; experienced RTs 27.0 ± 15.1, P = .007; and period 4: new graduate RTs 19.0 ± 14.5, P < .001, paired t test. The scores between new graduate RTs and experienced RTs during post-simulation were not significantly different for period 1 (P = .35) but were significantly different for periods 2-4 (P = .040, unpaired t test). CONCLUSIONS: The use of a competence-based orientation program showed educational advancements and helped determine successful orientation completion.

The characteristics of HIV and AIDS patients with deep vein thrombosis at Dr. George Mukhari Academic Hospital.

BACKGROUND: Deep vein thrombosis (DVT) is 10 times more prevalent in HIV and AIDS patients than in the general population and is more common in patients with severe immune suppression (CD4 < 200 cells/mL). Opportunistic infections render HIV and AIDS patients susceptible to a hypercoaguable state, including lower protein S levels. AIM AND SETTING: To present the profile of HIV and AIDS patients who developed DVT in the primary care wards of Dr. George Mukhari Academic Hospital (DGMAH), Garankuwa. METHODS: Cross-sectional study of clinical records of admitted HIV and AIDS patients without DVT to the primary care wards, DGMAH, from 01 February 2010 to 31 January 2011. RESULTS: Two hundred and twenty-nine patients were admitted and 17 (7.4%) developed DVT. Of those that developed DVT, eight (47%) had infection with tuberculosis (TB), four (24%) had pneumonia and four (24%) had gastroenteritis. The risk of developing DVT was 8/94 (8.5%) in those with TB, 4/53 (7.5%) in those with gastroenteritis and 4/75 (5.3%) in those with pneumonia. The mean duration of stay was 14.1 days in those with DVT versus 4.0 days in those without. CONCLUSION: HIV (and AIDS) is a hypercoaguable state and the risk of DVT is relatively high in patients with opportunistic infections. HIV and AIDS patients who are admitted to hospital with opportunistic infections may benefit from anti-thrombotic prophylaxis and further studies are needed to evaluate this.

Perceived Gender Ratings for High and Low Scorers on the Autism-Spectrum Quotient Consistent with the Extreme Male Brain Account of Autism.

The Extreme Male Brain (EMB) theory posits that autistic traits are linked to excessive exposure to testosterone in utero. While findings from a number of studies are consistent with this theory, other studies have produced contradictory results. For example, some findings suggest that rather than being linked to hypermasculinization for males, or defeminization for females, elevated levels of autistic traits are instead linked to more androgynous physical features. The current study provided further evidence relevant to the EMB and androgony positions by comparing groups of males selected for high or low scores on the Autism-spectrum Quotient (AQ) as to the rated masculinity of their faces and voices, and comparable groups of females as to the rated femininity of their faces and voices. The voices of High-AQ males were rated as more masculine than those of Low-AQ males, while the faces of High-AQ females were rated as less feminine than those of Low-AQ females. There was no effect of AQ group on femininity ratings for female voices or on masculinity ratings for male faces. The results thus provide partial support for a link between high levels of autistic-like traits and hypermasculinization for males and defeminization for females, consistent with the EMB theory.

Grouping in short-term memory: do oscillators code the positions of items?

According to several current models of short-term memory, items are retained in order by associating them with positional codes. The models differ as to whether temporal oscillators provide those codes. The authors examined errors in recall of sequences comprising 2 groups of 4 consonants. A critical manipulation was the precise timing of items within the groups, whereby temporal position (time from group onset) and ordinal position (number of items from group onset) were partially unconfounded. Errors that involve items migrating across groups should preserve within-group temporal position according to oscillator models, but should preserve within-group ordinal position according to nonoscillator models. Results from the intergroup errors strongly favored preservation of ordinal rather than temporal position.

Grouping in short-term verbal memory: is position coded temporally?

The nature of the mechanisms that code item position in serial short-term verbal recall was investigated with reference to temporal grouping phenomena--effects that arise when additional pauses are inserted in a presented list to form groups of items. Several recent models attempt to explain these phenomena by assuming that positional information is retained by associating items with contextual information. According to two of the models--the Phonological Loop model (Hitch, Burgess, Towse, & Culpin, 1996) and the OSCAR model (Brown, Preece, & Hulme, 2000)--contextual information depends critically on the timing of item presentation with reference to group onset. By contrast, according to the Start-End model (Henson, 1998) and a development from it, which we label the Oscillator-Revised Start-End model (Henson & Burgess, 1997), contextual information is independent of time from group onset. Three experiments examined whether coding of position is time dependent. The critical manipulation was to vary stimulus-onset asynchrony from one group to the next in the same list. Lists of consonants were presented visually, but with vocalization in Experiment 1, auditorily in Experiment 2, and auditorily with articulatory suppression in Experiment 3. The pattern of order errors consistently favoured the predictions of the time-independent models over those of the time-dependent models in that across-group transpositions reflected within-group serial position rather than time from group onset. Errors involving intrusions from previous lists also reflected within-group serial position, thereby extending support for the time-independent models.

Uterine artery embolization--a successful treatment to control bleeding cervical pregnancy with a simultaneous intrauterine gestation.

A case of a woman suffering from a bleeding heterotopic cervical pregnancy is described. The concurrent cervical pregnancy and intrauterine gestation were diagnosed by ultrasound and bleeding was initially controlled with selective fluoroscopic uterine artery embolization. A selective fetal reduction was done with ultrasound-guided intracardiac potassium chloride. Uterine artery embolization has been used successfully to control haemorrhage in cervical pregnancies when the main goal was to allow preservation of the uterus, thus maintaining potential fertility. This is the first report of arterial embolization used to control bleeding for maintaining a concurrent intrauterine heterotopic pregnancy in an in-vitro fertilization patient. Unfortunately, subsequent conservative measures led to undesired outcome. This procedure initially controlled the bleeding without disrupting the intrauterine fetal cardiac activity.

The presence of serum antibody to the chlamydial heat shock protein (CHSP60) as a diagnostic test for tubal factor infertility.

OBJECTIVE: To study the utility of testing for heat shock protein 60 (CHSP60) antibodies in the diagnosis of tubal factor infertility. DESIGN: Prospective case control. SETTING: Canadian university hospital infertility clinic. PATIENT(S): Women presenting for infertility investigation. INTERVENTION(S): Sera were collected from 77 patients. MAIN OUTCOME MEASURE(S): The relationship between tubal factor infertility and the presence of antibodies to Chlamydia trachomatis and CHSP60 was assessed. RESULT(S): There were no significant differences between antibodies to C. trachomatis in women with tubal factor infertility (63%) and other causes of infertility (46%). However, more women with tubal factor infertility (44%) had anti-CHSP60 antibodies compared with other causes of infertility (8%). Antibody testing for C. trachomatis has only a 63% sensitivity and a 54% specificity for detecting tubal factor infertility. In contrast, the CHSP60 antibody test has a 44% sensitivity and a 92% specificity for detecting tubal factor infertility. There is a good positive likelihood ratio of 5.5 for CHSP60 antibody testing detecting the presence of tubal factor infertility. Combining CHSP60 antibody with antibody testing for C. trachomatis has an excellent positive likelihood ratio of 10 for the detection of C. trachomatis-associated tubal factor infertility. CONCLUSION(S): CHSP60 antibody testing is a more accurate test than antibody testing for C. trachomatis for predicting chlamydia-associated tubal factor infertility. These tests, when used in combination at initial infertility evaluation, would provide a rapid noninterventive means of diagnosing tubal factor infertility.