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1.
Breast Cancer Res Treat ; 174(2): 469-477, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30515680

RESUMO

INTRODUCTION: Breast cancer (BC) is the leading cause of cancer death in Caribbean women. Across the Caribbean islands, the prevalence of hereditary breast cancer among unselected breast cancer patients ranges from 5 to 25%. Moreover, the prevalence of BC among younger women and the high mortality in the Caribbean region are notable. This BC burden presents an opportunity for cancer prevention and control that begins with genetic testing among high-risk women. Measured response to positive genetic test results includes the number of preventive procedures and cascade testing in family members. We previously reported data on an active approach to promote cascade testing in the Bahamas and report on preventive procedures showing moderate uptake. Here, we describe a clinically structured and community-partnered approach to the dissemination and follow-up of genetic test results including family counseling for the promotion of risk mitigation strategies and cascade testing in our Trinidadian cohort of patients tested positive for BC predisposition genes. METHODS: As a part of our initial study of BC genetic testing in Trinidad and Tobago, all participants received pre-test counseling including three-generation pedigree and genetic testing for BRCA1/2, PALB2, and RAD51C. The study was approved by the University of Miami IRB and the Ethics Committee of the Ministry of Health, Trinidad and Tobago. We prospectively evaluated a clinically structured approach to genetic counseling and follow-up of BC mutation carriers in Trinidad and Tobago in 2015. The intervention consisted of (1) engaging twenty-nine BC patients with a deleterious gene mutation (probands), and (2) invitation of their at-risk relatives to attend to a family counseling session. The session included information on the meaning of their results, risk of inheritance, risk of cancer, risk-reduction options, offering of cascade testing to family members, and follow-up of proband decision-making over two years. RESULTS: Twenty-four of twenty-nine mutation carriers (82.8%) consented to enroll in the study. At initial pedigree review, we identified 125 at-risk relatives (ARR). Seventy-seven ARR (62%) attended the family counseling sessions; of these, 76 ARR (99%) consented to be tested for their family gene mutation. Genetic sequencing revealed that of the 76 tested, 35 (46%) ARR were carriers of their family mutation. The ARR received their results and were urged to take preventative measures at post-test counseling. At 2-year follow-up, 6 of 21 probands with intact breasts elected to pursue preventive mastectomy (28.5%) and 4 of 20 women with intact ovaries underwent RRSO (20%). CONCLUSIONS: In Trinidad and Tobago, a clinically structured and partnered approach to our testing program led to a significant rate of proband response by completing the intervention counseling session, executing risk-reducing procedures as well as informing and motivating at-risk relatives, thereby demonstrating the utility and efficacy of this BC control program.


Assuntos
Neoplasias da Mama/genética , Aconselhamento Genético/métodos , Testes Genéticos/métodos , Mutação em Linhagem Germinativa , Análise de Sequência de DNA/métodos , Adulto , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/diagnóstico , Proteínas de Ligação a DNA/genética , Proteína do Grupo de Complementação N da Anemia de Fanconi/genética , Feminino , Predisposição Genética para Doença , Heterozigoto , Humanos , Pessoa de Meia-Idade , Linhagem , Mastectomia Profilática/estatística & dados numéricos , Estudos Prospectivos , Trinidad e Tobago/epidemiologia , Adulto Jovem
2.
Am Surg ; 85(12): 1318-1326, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31908212

RESUMO

The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma , Manequins , Traumatologia/educação , Cuidados de Suporte Avançado de Vida no Trauma/métodos , Estudos Cross-Over , Currículo , Humanos , Pericardiocentese/educação , Estudantes de Medicina , Toracostomia/educação
3.
Breast Cancer Res Treat ; 159(1): 131-8, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27469594

RESUMO

The mortality rate from breast cancer in the nation of Trinidad and Tobago is among the highest of any country in the Caribbean region. The contribution of inherited gene mutations to the burden of breast cancer in Trinidad and Tobago has not been studied. We examined the prevalence of mutations in three susceptibility genes (BRCA1, BRCA2, and PALB2) in breast cancer patients in Trinidad and Tobago. We studied 268 unselected breast cancer patients from Trinidad and Tobago and looked for mutations across the entire coding sequences of BRCA1, BRCA2, and PALB2. Overall, 28 of 268 patients (10.4 %) had a mutation in one of the three genes, including 15 in BRCA1, ten in BRCA2, two in PALB2, and one in both BRCA2 and PALB2. There were 25 different mutations identified; of these, four mutations were seen in two patients each. Given the high prevalence of mutations, it is reasonable to offer genetic testing for these three genes to all breast cancer patients in Trinidad and Tobago.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/genética , Proteína do Grupo de Complementação N da Anemia de Fanconi/genética , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Pessoa de Meia-Idade , Taxa de Mutação , Prevalência , Análise de Sequência de DNA , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia , Adulto Jovem
4.
Bull Emerg Trauma ; 4(2): 75-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27331063

RESUMO

OBJECTIVE: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE). METHODS: This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases. RESULTS: There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503). CONCLUSION: ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.

5.
Indian J Surg ; 77(Suppl 2): 227-31, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26729998

RESUMO

The Rural Trauma Team Development Course (RTTDC) was devised to optimize trauma resuscitation training in under-resourced rural institutions. This program appears ideal for India because of its dense traffic, large population, and high frequency of rural trauma. We report on the feasibility and desirability of introducing RTTDC in India. An instructor course for 20 faculties and a provider course for 23 were conducted in New Delhi, India. The courses were evaluated by multiple choice question (MCQ) performance, by rating the modules on a three-point scale (1 = very relevant, 2 = relevant, and 3 = not relevant) for communication skills, principles of performance improvement and patient safety (PIPS), and clinical scenarios. Evaluation questionnaires including desirability of promulgation in India were completed using a five-point Likert Scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Overall written comments were also provided. Both faculty and providers improved post-course MCQ scores (p < 0.05) with lower scores in the provider group. Seventy-eight percent faculty and 74 % providers rated the communication module very relevant. PIPS was rated very relevant by 72 % faculty and 65 % providers. There were over 150 comments, generally positive with over 90 % of both faculty and providers rating strongly agree to agree that the course be promulgated widely in India. The RTTDC including plans for promulgation was enthusiastically received in India, and its potential for improving trauma care including communication skills and PIPS appears excellent.

6.
J Surg Res ; 184(1): 551-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23541174

RESUMO

BACKGROUND: The internationally recognized Advanced Trauma Operative Management (ATOM) course uses a 1:1 student-to-faculty teaching model. This study examines a two student to one faculty ATOM teaching model. MATERIALS AND METHODS: We randomly assigned 16 residents to four experienced ATOM faculty members. Half started with the one-student model and the other half with the two-student model and then switched using the same faculty. Students and faculty completed forms on the educational value of the two models (1 = very poor; 2 = poor; 3 = average; 4 = good; and 5 = excellent) and identified educational preferences and recommendations. RESULTS: We assigned educational values for the 13 procedures as follows: All faculty rated the one-student model as excellent; six members rated the two-student model as excellent, and seven as good. Students rated 50%-75% as excellent and 12%-44% as good for the two-student model, and 56%-81% as excellent and 12%-44% as good for the one-student model. Given resource constraints, all faculty and 88% of students preferred the two-student model. With no resource constraints, 75% of students and 50% of faculty chose the two-student model. All faculty and students rated both models "acceptable." Overall, 81% of students and 50% of faculty rated the two-student model better. All faculty members recommended that the models be optional; 94% of students recommended that they be either optional (50%) or a two-student model (44%). Performing or assisting on each procedure twice was considered an advantage of the two-student model. CONCLUSIONS: The two-student teaching model was acceptable and generally preferred in this study. With appropriately trained faculty and students, the two-student model is feasible and should result in less animal usage and possibly wider promulgation.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Docentes de Medicina , Internato e Residência/métodos , Estudantes de Medicina/psicologia , Ferimentos e Lesões/terapia , Atitude do Pessoal de Saúde , Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Internato e Residência/organização & administração , Aprendizagem , Modelos Educacionais
7.
J Surg Educ ; 70(2): 258-64, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23427974

RESUMO

OBJECTIVES: The advanced trauma life support (ATLS) course has become the international standard for teaching trauma resuscitation skills. The 2 to 2.5 days course is usually offered as an on-site teaching experience. The present project assesses the potential for applying telemedicine technology to teaching ATLS by distance learning. DESIGN: Two groups of equally trained first-year family practice residents were randomly assigned to a standard on-site ATLS course or one delivered by telemedicine. The 2 courses were compared by evaluating post-ATLS multiple-choice question test performance, instructor evaluation of student skill station performance, overall pass rate, participant rating of each component of the course, and overall feedback on the educational quality of the course (rating scale 1-4). RESULTS: The mean scores for the 2 groups (with the standard ATLS and with the telemedicine, respectively) were not statistically significantly different: post-ATLS multiple-choice question-89.69% vs 85.89%; pass rate for the course was the same for both models; instructor overall evaluation of student skill station performance-3.12 vs 3.00; and participant overall feedback on all components of the course-3.67 vs 3.91. CONCLUSIONS: Our results suggest that telemedicine technology could be successfully applied to teaching ATLS courses.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma , Educação Médica/métodos , Telemedicina , Competência Clínica
9.
J Surg Res ; 162(1): 7-10, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20452620

RESUMO

BACKGROUND: Mechanical simulators may be an acceptable substitute for the live patient model in trauma skills teaching and assessment. We compare these models in the initial assessment station of the Advanced Trauma Life Support (ATLS) course. METHODS: After a pilot project utilizing both models in a provider ATLS course it appeared that the mechanical model would be satisfactory for ATLS teaching and assessment. Instructors (n = 32) and ATLS Students (n = 64) were randomly selected from our database and completed a questionnaire evaluating the patient model and the simulator after viewing a video in which the simulator replaced the patient model. The evaluators indicated whether the patient and simulator models were satisfactory and then compared them by indicating whether there was any difference between the models, indicating which was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. Comments were also written in the evaluation form. RESULTS: All 32 instructors and 64 students indicated that both the patient and simulator models were satisfactory for teaching and testing ATLS resuscitation skills. At least 62 of the 64 students rated the simulator higher in all categories. Two students rated the patient model as more realistic and two noted no difference in terms of being more interesting. All 32 instructors indicated that the simulator was more challenging, interesting, dynamic, and better overall. Two of the 32 instructors indicated that the patient model was more enjoyable and two indicated that there was no difference as far as the models being realistic. Comments included inability to hear breath sounds that were changing in the patient model as opposed to the simulator model, and the simulator was more interesting and dynamic because the hemodynamic and physiologic parameters could be witnessed without being prompted by the instructor. One main concern expressed by the participants was the more costly simulator, and two instructors indicated that the scenarios could be improved to fit the superior capabilities of the simulator. CONCLUSIONS: There was strong support from both students and instructors for the use of the simulator as a satisfactory substitute for the live patient model. The cost of the simulator is considered a significant issue. However, in centers where simulators are readily available, it appears from our data that it is a very satisfactory substitute for the patient model in teaching and assessing trauma resuscitation skills in the ATLS program.


Assuntos
Cuidados Críticos , Internato e Residência/métodos , Modelos Anatômicos , Simulação de Paciente , Ressuscitação/educação , Estudos Transversais , Humanos , Projetos Piloto , Distribuição Aleatória
10.
Artigo em Inglês | MEDLINE | ID: mdl-20044306

RESUMO

Density functional theory (DFT) calculations have been carried out at the hybrid Becke 3-Lee-Yang-Parr; B3LYP/3-21G** level of theory to study two series of hydroxy-chalca-acetic acid-(4-pyrrolidin-1-yl-phenyl) ester [C(60)-C(2)H(4)N-(4-XCOCH(2)OH)C(6)H(4)] and hydroxy-chalcoacetic acid-[2-(2-hydroxy-acetylchalcanyl)-4-pyrrolidin-1-yl-phenyl] ester[C(60)-C(2)H(4)N-(3,4-XCOCH(2)OH)C(6)H(4)]. The X atom is O, S or Se for the two series. The vibrational spectra, physical, chemical, thermodynamics and Quantitative Structure Activity Relationship (QSAR) properties of the studied molecules are calculated and discussed. We have evaluated these molecules as HIV-1 protease inhibitors based on the hydrogenation interaction between the hydroxymethylcarbonyl (HMC) groups and the two aspartic acid of the HIV-1 protease active site. Results show that some of the investigated fullerene-based derivatives can be considered promising as HIV-1 protease inhibitors.


Assuntos
Fulerenos/química , Inibidores da Protease de HIV/química , Protease de HIV/química , Inibidores da Protease de HIV/síntese química , Humanos , Modelos Químicos , Estrutura Molecular , Conformação Proteica , Relação Quantitativa Estrutura-Atividade , Termodinâmica
11.
Can J Surg ; 52(4): 271-276, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19680510

RESUMO

BACKGROUND: The decision to perform laparotomy in blunt trauma patients is often difficult owing to pelvic fractures; however, once the decision is made, delay or failure to perform laparotomy could affect morbidity and mortality. We sought to identify predictors of laparotomy and mortality in polytrauma patients with pelvic fractures. METHODS: We divided 390 blunt polytrauma patients (Injury Severity Score [ISS] >/= 16) with pelvic fractures into laparotomy (n = 56) and nonlaparotomy (n = 334) groups. We assessed the role of the following variables in predicting laparotomy and mortality: age, sex, hypotension, fluid and blood transfusions, positive abdominal computed tomography (CT) scans or focused assessment with sonography for trauma (FAST) examination, pelvic fracture severity and ISS. We analyzed the data using Student t and chi(2) tests, followed by logistic regression analysis. RESULTS: Mortality was higher in the laparotomy group than the nonlaparotomy group (28.6% v. 12.9%; overall mortality 15.1%). The laparotomy group had higher mean ISS (36.9 v. 24.9), higher mean abbreviated injury scores (AIS) for the abdomen (2.6 v. 0.9) and chest (3.4 v. 1.6), lower mean initial hemoglobin levels (105.2 v. 127.0 g/L), higher mean crystalloid (4249 v. 3436 mL) and blood transfusion volumes over 4 hours (12.1 v. 3.9 units), more frequent hypotension (44.6 v. 18.0%) and a higher percentage of positive CT scans (67.9% v. 28.4%) and FAST examination results (42.9% v. 3.3%) than the nonlaparotomy group. Age (mean 53.7 v. 41.5 yr); ISS (mean 39.0 v. 24.4); AIS for the head (mean 3.2 v. 1.7), abdomen (mean 1.6 v. 1.1), chest (mean 2.7 v. 1.8) and pelvis (mean 3.1 v. 2.6); crystalloid (mean 5157.3 v. 3266.4 mL) and blood transfusion volumes over 4 hours (mean 13.1 v. 3.7) and initial hypotension (61% v. 14.8%) were all greater among patients who died than those who survived. Mean initial hemoglobin levels were lower among patients who died than among those who survived (111.1 v. 126.2 g/L). Age, the AIS for the head, initial hypotension and low initial hemoglobin levels were highly predictive of mortality, whereas low initial hemoglobin levels, a positive FAST examination and high AIS for the abdomen and chest were all highly predictive of laparotomy. CONCLUSION: Among the polytrauma patients with pelvic fractures, 14.3% underwent laparotomy, and mortality was higher among these patients than among those who did not have the procedure. The predictors of laparotomy and mortality are similar to those anticipated in patients without pelvic fractures.

12.
J Trauma ; 66(1): 98-102, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19131811

RESUMO

BACKGROUND: We have previously demonstrated improved medical student performance using standardized live patient models in the Trauma Evaluation and Management (TEAM) program. The trauma manikin has also been offered as an option for teaching trauma skills in this program. In this study, we compare performance using both models. METHODS: Final year medical students were randomly assigned to three groups: group I (n = 22) with neither model, group II (n = 24) with patient model, and group III (n = 24) with mechanical model using the same clinical scenario. All students completed pre-TEAM and post-TEAM multiple choice question (MCQ) exams and an evaluation questionnaire scoring five items on a scale of 1 to 5 with 5 being the highest. The items were objectives were met, knowledge improved, skills improved, overall satisfaction, and course should be mandatory. Students (groups II and III) then switched models, rating preferences in six categories: more challenging, more interesting, more dynamic, more enjoyable learning, more realistic, and overall better model. Scores were analyzed by ANOVA with p < 0.05 being considered statistically significant. RESULTS: All groups had similar scores (means % +/- SD)in the pretest (group I - 50.8 +/- 7.4, group II - 51.3 +/- 6.4, group III - 51.1 +/- 6.6). All groups improved their post-test scores but groups II and III scored higher than group I with no difference in scores between groups II and III (group I - 77.5 +/- 3.8, group II - 84.8 +/- 3.6, group III - 86.3 +/- 3.2). The percent of students scoring 5 in the questionnaire are as follows: objectives met - 100% for all groups; knowledge improved: group I - 91%, group II - 96%, group III - 92%; skills improved: group I - 9%, group II - 83%, group III - 96%; overall satisfaction: group I - 91%, group II - 92%, group III - 92%; should be mandatory: group I - 32%, group II - 96%, group III - 100%. Student preferences (48 students) are as follows: the mechanical model was more challenging (44 of 48); more interesting (40 of 48); more dynamic (46 of 48); more enjoyable (48 of 48); more realistic (32/48), and better overall model (42 of 48). CONCLUSIONS: Using the TEAM program, we have demonstrated that improvement in knowledge and skills are equally enhanced by using mechanical or patient models in trauma teaching. However, students overwhelmingly preferred the mechanical model.


Assuntos
Educação de Graduação em Medicina/métodos , Manequins , Simulação de Paciente , Ressuscitação/educação , Ensino/métodos , Traumatologia/educação , Análise de Variância , Avaliação Educacional , Humanos , Inquéritos e Questionários
13.
J Trauma ; 65(5): 1186-93, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19001992

RESUMO

The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. The integration of simulators into medical student curriculum, residency training, and continuing medical education has been strongly recommended by the American College of Surgeons as an innovative means of enhancing patient safety, reducing medical errors, and performing a systematic evaluation of various competencies. Advanced human patient simulators are increasingly being used in trauma as an evaluation tool to assess clinical performance and to teach and reinforce essential knowledge, skills, and abilities. A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Simulação de Paciente , Aprendizagem Baseada em Problemas , Traumatologia/educação , Ferimentos e Lesões/terapia , Competência Clínica , Educação Médica , Escolaridade , Humanos , Ferimentos e Lesões/cirurgia
14.
Can J Surg ; 51(3): 185-9, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18682791

RESUMO

BACKGROUND: The Advanced Trauma Operative Management (ATOM) course was first introduced into Canada in 2003 at the University of Toronto, with senior general surgery residents being the primary focus. We present an assessment of the course in this Canadian general surgery residency program. METHODS: We compared trainees' pre-and postcourse self-efficacy scores and multiple choice question (MCQ) examination results, using paired t tests and resident (n = 24) and faculty (n = 7) course ratings made according to a 10-item, 5-point Likert scale. Faculty were previously trained as ATOM instructors. RESULTS: Mean pre-and postcourse self-efficacy scores were 68.9 (standard deviation [SD] 24.0) and 101.4 (SD 14.8), respectively (p < 0.001). Mean pre-and post-MCQ scores were 16.4 (SD 3.2) and 18.8 (SD 2.7), respectively (p = 0.006). On the Likert scale (1 = strongly disagree, 5 = strongly agree), all faculty and residents rated the following items as 4-5: objectives were met; knowledge, skills, clinical training, judgment and confidence improved; the live animal is a useful representation of clinical trauma; and the course should be continued but would be more appropriate for the fourth rather than the fifth year of residency. Residents rated as 1-2 the item that the human cadaver would be preferable for learning the surgical skills. Of 24 residents, 20 rated as 3 or less the item stating that the course prepares them for trauma management more adequately than their regular training program. CONCLUSION: Self-efficacy, trauma knowledge and skills improved significantly with ATOM training. Preference was expressed for the live animal versus cadaver model, for ATOM training in the fourth rather than fifth year of residency and for the view that it complements general surgery trauma training. The data suggest that including ATOM training in Canadian general surgical residency should be considered.


Assuntos
Cirurgia Geral/educação , Internato e Residência , Traumatologia/educação , Competência Clínica , Currículo , Avaliação Educacional , Humanos , Ontário , Avaliação de Programas e Projetos de Saúde
15.
J Trauma ; 64(6): 1638-50, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18545134

RESUMO

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.


Assuntos
Currículo/normas , Educação Médica Continuada , Cuidados para Prolongar a Vida/normas , Traumatologia/educação , Ferimentos e Lesões/terapia , Competência Clínica , Currículo/tendências , Medicina de Emergência/educação , Tratamento de Emergência/normas , Tratamento de Emergência/tendências , Feminino , Previsões , Humanos , Cuidados para Prolongar a Vida/tendências , Masculino , Ressuscitação/educação , Sensibilidade e Especificidade , Traumatologia/tendências , Estados Unidos
17.
Appl Spectrosc ; 62(3): 306-11, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18339239

RESUMO

The greater Cairo region is the most populated area in Egypt. The aquatic environment of the Nile River in this area is being affected by industrial activities. The study of the molecular structure of sediment may provide a good trace for such changes. Both Fourier transform infrared spectroscopy (FT-IR) and density functional theory (DFT) were used to study the effect of industrial waste disposal south of Cairo on the molecular structure of Nile River sediment. Four seasonal samples were collected from six sites covering 75 km along the Nile River. Grain sizes of 200 microm, 125 microm, 65 microm, and 32 microm, respectively, were examined. The results indicate that hydrated aluminum hydroxide controls the distribution of organic matter in the different grain sizes. Furthermore, the hydration of phenol may take place in grain sizes lower than 200 microm, which is indicated by the OH stretching at 3550 cm(-1) and verified by the obtained model. The formation of metal carboxylate bonds at 1638 cm(-1) (asymmetric) and 1382 cm(-1) (symmetric) indicate the possible interaction between heavy metals and other organic structures, mainly humic substances.


Assuntos
Sedimentos Geológicos/química , Rios/química , Poluentes Químicos da Água/análise , Egito , Estações do Ano , Espectroscopia de Infravermelho com Transformada de Fourier
18.
J Trauma ; 62(6): 1416-20, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17563658

RESUMO

BACKGROUND: Student feedback from the old TEAM (Trauma Evaluation and Management) program prompted introduction of simulated trauma patient models in the new program. Performance after the new and old programs was compared to assess the impact of the simulated patient models. METHODS: Final year medical students randomly assigned to control and experimental groups completed a 20-item trauma multiple choice questionnaire examination (MCQE). The experimental groups attended the old or new TEAM program before completing a second MCQE and the control groups completed the same post-test without the TEAM programs. We used paired t tests for within and unpaired t tests for between group comparisons of the control and experimental groups' performances on the MCQ pre- and post-tests. On a 1 to 5 scale, students graded if objectives were met; trauma knowledge improved; trauma skills improved; overall satisfaction; and if TEAM should be mandatory. RESULTS: Post-test scores increased significantly after both the old and new programs but the increase was statistically significantly greater after the new program. In the old TEAM, 51.6% rated improvement in trauma skills at 4 or greater compared with 97.3% in the new program. A large percentage of students in the old program requested more hands-on teaching. Of students, 85% scored honors pass mark after completion of the new TEAM format, and no honors pass marks were achieved after completion of the old TEAM format. CONCLUSION: Simulated trauma patient models were rated highly and improved both trauma skills and knowledge. Wider application of these teaching models is suggested.


Assuntos
Educação de Graduação em Medicina/métodos , Simulação de Paciente , Ensino , Ferimentos e Lesões , Avaliação Educacional , Humanos , Inquéritos e Questionários
19.
J Surg Res ; 139(2): 229-35, 2007 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-17161432

RESUMO

BACKGROUND: The use of simulation as a teaching adjunct in Advanced Trauma Life Support (ATLS) has not undergone rigorous psychometric testing. We hypothesized that an advanced, computer-controlled human patient simulator (HPS) would be a useful adjunct to the ATLS shock skills station. MATERIALS AND METHODS: Forty-four PGY-1 residents enrolled in ATLS courses were randomized into control (CTL) and experimental (EXP) groups. All students took a shock-specific pre- and post-test multiple choice question examination (MCQE). The EXP group used the HPS in the shock skills station; the CTL group was taught in a traditional manner. All students participated in an experimental, shock-specific objective structured clinical examination (OSCE) session at the end and had their performance evaluated. The EXP group was asked to evaluate the teaching effectiveness of the shock skills station. RESULTS: There were no statistically significant differences between the EXP and CTL groups with respect to the pre- and post-test MCQE or the change in scores. The groups were similar in their overall performance during the shock-specific OSCE. The EXP and CTL groups were equivalent with respect to shock recognition, identification of the type of shock, and ability to select the correct treatment plan. The shock skills station was rated from very good to excellent in 91% of the EXP group versus 63% in the CTL group. The EXP group rated the simulator most helpful in learning to analyze data from the monitors. CONCLUSIONS: Use of an advanced HPS during the ATLS shock skills station was equivalent to traditional teaching scenarios based on psychometric testing. Students subjectively preferred the simulator as a teaching tool and found it most useful in learning how to integrate data from hemodynamic monitors into clinical decision making.


Assuntos
Educação Médica Continuada/métodos , Cuidados para Prolongar a Vida , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/terapia , Simulação de Paciente , Choque/diagnóstico , Choque/terapia , Competência Clínica , Computadores , Educação Médica Continuada/normas , Humanos
20.
J Trauma ; 59(1): 43-8, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16096537

RESUMO

BACKGROUND: We compared base trauma knowledge and the impact of the Trauma Evaluation and Management (TEAM) program among senior medical students in seven countries. METHODS: We compared pre- and post-TEAM multiple choice question scores of fourth-year students in Jamaica (n = 32), Trinidad (n = 32), Costa Rica (n = 64), Australia (n = 35), United Arab Emirates (n = 68), Toronto (n = 29) and Pennsylvania (n = 34). Means and degree of improvement were compared by analysis of variance (p < 0.05 for statistical significance). Percentage pass (based on 70% or 60% pass mark), student's perception of instruction level, and grading of TEAM (based on the percentage of students grading 1-5 for each category) were assessed by chi2 analysis. [table: see text]. RESULTS: Only 31.4% of students achieved the borderline pass mark of 60%, and 5.4% achieved a clear pass mark of 70%. The performance before and after TEAM was quite variable among medical schools. A grade of > or = 4 was assigned by 74% to 100% for objectives, knowledge improvement, satisfaction, and recommending TEAM for the curriculum. TEAM was rated "just right" by 70.3% to 92.7%, "too simple" by 1.6% to 21.6%, and "too advanced" by 3.3% to 13.5% of students. CONCLUSION: Base trauma knowledge in these students, though variable, was generally very low and improved with TEAM. Our data suggest a need for greater undergraduate emphasis in trauma education.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Traumatologia/educação , Análise de Variância , Distribuição de Qui-Quadrado , Avaliação Educacional , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina
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