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Clinical Environment (clinical + environment)
Selected AbstractsProblem-based Learning in Undergraduate Dental Education: Faculty Development at the University of Southern California School of DentistryJOURNAL OF PROSTHODONTICS, Issue 5 2007Timothy R. Saunders DDS The University of Southern California School of Dentistry (USCSD) seeks to educate oral health professionals with a balanced curriculum covering health promotion, risk assessment and disease prevention, diagnostics, treatments, and therapeutics. Based on critical analyses of a 5-year educational demonstration project, the USCSD proposed to use problem-based learning (PBL) to achieve its goals. Among the many changes required to convert a traditional dental educational curriculum to PBL, none is more important than that of faculty development. To achieve this, the USCSD Curriculum Subcommittee on Faculty Development, Mentoring, and Evaluation has designed and implemented a series of workshops to train its faculty as facilitators. There are four Core Skills Workshops: PBL Process Workshop, Facilitation of Learning Workshop, Student Assessment and Feedback Workshop, and PBL in the Clinical Environment. [source] Worldwide distribution of Pseudomonas aeruginosa clone C strains in the aquatic environment and cystic fibrosis patientsENVIRONMENTAL MICROBIOLOGY, Issue 7 2005Ute Römling Summary Highly successful bacterial clones have the ability to effectively colonize environmental niches and patients. However, the factors which determine the complex interplay between the colonization of environmental niches and patients are mainly unknown. In this study we show that Pseudomonas aeruginosa clone C strains are distributed worldwide and highly prone to infect cystic fibrosis (CF) patients in Canada, England, France and Germany. In Hanover, Germany and Vancouver, Canada, clone C strains are highly prevalent in the CF patient community, although the mechanisms of acquisition may have been different. All clone C strains showed highly related macrorestriction fragment pattern of the whole genome as visualized by pulsed-field gel electrophoresis and harboured the 102 kbp plasmid pKLC102. Comparison of three prevalent P. aeruginosa clones with different distribution between the environment and patients revealed that neither enhanced biofilm formation nor antibiotic resistance was responsible for the spread of clone C. Clone M, which was highly prevalent in the clinical environment such as sanitary facilities, lacked motility, which could explain its relatively low prevalence in CF patients. Elucidation of the mechanisms which lead to the prevalence of clone C strain in patients and the environment requires the investigation of additional phenotypes. [source] Investigation of critical inter-related factors affecting the efficacy of pulsed light for inactivating clinically relevant bacterial pathogensJOURNAL OF APPLIED MICROBIOLOGY, Issue 5 2010H.P. Farrell Abstract Aims:, To investigate critical electrical and biological factors governing the efficacy of pulsed light (PL) for the in vitro inactivation of bacteria isolated from the clinical environment. Development of this alternative PL decontamination approach is timely, as the incidence of health care,related infections remains unacceptably high. Methods and Results:, Predetermined cell numbers of clinically relevant Gram-positive and Gram-negative bacteria were inoculated separately on agar plates and were flashed with ,60 pulses of broad-spectrum light under varying operating conditions, and their inactivation measured. Significant differences in inactivation largely occurred depending on the level of the applied lamp discharge energy (range 3·2,20 J per pulse), the amount of pulsing applied (range 0,60 pulses) and the distance between light source and treatment surface (range 8,20 cm) used. Greater decontamination levels were achieved using a combination of higher lamp discharge energies, increased number of pulses and shorter distances between treatment surface and the xenon light source. Levels of microbial sensitivity also varied depending on the population type, size and age of cultures treated. Production of pigment pyocynanin and alginate slime in mucoid strains of Pseudomonas aeruginosa afforded some protection against lethal action of PL; however, this was evident only by using a combination of reduced amount of pulsing at the lower lamp discharge energies tested. A clear pattern was observed where Gram-positive bacterial pathogens were more resistant to cidal effects of PL compared to Gram negatives. While negligible photoreactivation of PL-treated bacterial strains occurred after full pulsing regimes at the different lamp discharge energies tested, some repair was evident when using a combination of reduced pulsing at the lower lamp discharge energies. Strains harbouring genes for multiple resistances to antibiotics were not significantly more resistant to PL treatments. Slight temperature rises (,4·2°C) were measured on agar surfaces after extended pulsing at higher lamp discharge energies. Presence of organic matter on treatment surface did not significantly affect PL decontamination efficacy, nor did growth of PL-treated bacteria on selective agar diminish survival compared to similarly treated bacteria inoculated and enumerated on nonselective agar plates. Conclusions:, Critical inter-related factors affecting the effective and repeatable in vitro decontamination performance of PL were identified during this study that will aid further development of this athermal process technology for applications in health care and in industry. Very rapid reductions (c. 7 log10 CFU cm,2 within ,10 pulses) occurred using discharge energy of 20 J for all tested clinically relevant bacteria under study when treated at 8 cm distance from xenon light source. While no resistant flora is expected to develop for treatment of microbial pathogens on two-dimensional surfaces, careful consideration of scale up factors such as design and operational usage of this PL technique will be required to assure operator safety. Significance and Impact of the Study:, Findings and conclusions derived from this study will enable further development and optimization of this decontamination technique in health care and in food preparation settings, and will advance the field of nonthermal processing technologies. [source] Supervising medication administration by undergraduate nursing students: influencing factorsJOURNAL OF CLINICAL NURSING, Issue 5-6 2010Kerry Reid-Searl Background., The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required. Aims and objectives., The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting. Design., A grounded theory approach was used with constant comparative analysis to identify categories from the data. Methods., The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia. Results., Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time. Conclusions., The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment. Relevance to clinical practice., The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented. [source] A study of nurses' inferences of patients' physical painJOURNAL OF CLINICAL NURSING, Issue 4 2006Benita Wilson BSc Aim., The aim of this study was to establish if postregistration education and clinical experience influence nurses' inferences of patients' physical pain. Background., Pain is a complex, subjective phenomenon making it an experience that is elusive and difficult to define. Evaluation of an individual's pain is the product of a dynamic, interactive process that frequently results in ineffective pain management. Educating nurses should address the deficit, however the clinical environment is thought to be most influential in the acquisition of knowledge. Design., A series of vignettes was used to consider nurses' inferences of physical pain for six hypothetical patients; these were employed within a self-administered questionnaire that also addressed lifestyle factors of patients in pain, general attitudes and beliefs about pain management and general knowledge of pain control. Method., One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. Results., The specialist nurses tended to infer lower levels of physical pain than the general nurses when considering the patients in the vignettes. Conclusion., Education and clinical experience influence nurses' knowledge, attitudes and beliefs about pain. However, it would appear that the specialist nurses' working environment and knowledge base engenders a practice theory divide, resulting in desensitization to patients' physical pain. Relevance to clinical practice., It is suggested that the specialist nurses use defence mechanisms to protect them from the conflict that arises from working within the clinical environment. These cognitive strategies have the potential to ease cognitive dissonance for the nurse, but may increase patient suffering. [source] Clinical education facilitators: a literature reviewJOURNAL OF CLINICAL NURSING, Issue 6 2005Veronica Lambert BNS Aims and objectives., The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. Background., The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory,practice gap. Method., Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. Results., Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. Conclusions., It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. Relevance to clinical practice., A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory,practice divide. [source] Adding another spectral dimension to 1H magnetic resonance spectroscopy of hepatic encephalopathy,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2005Nader Binesh PhD Abstract Purpose To evaluate a localized two-dimensional correlated magnetic resonance spectroscopic (L-COSY) technique in patients with hepatic encephalopathy (HE) and healthy subjects, and to correlate the cerebral metabolite changes with neuropsychological (NP) test scores. Materials and Methods Eighteen minimal hepatic encephalopathy (MHE) patients and 21 healthy controls have been investigated. A GE 1.5-T magnetic resonance (MR) scanner was used in combination with a body MR coil for transmission and a 3-inch surface coil for reception. A 27-mL voxel was localized by three slice-selective radio frequency (RF) pulses (90°-180°-90°) in the anterior cingulate region. The total duration of each two-dimensional L-COSY spectrum was approximately 25 minutes. The NP battery included a total of 15 tests, which were grouped into six domains. Results MR spectroscopic results showed a statistically significant decrease in myo-inositol (mI) and choline (Ch) and an increase in glutamate/glutamine (Glx) in patients when compared to healthy controls. There was also an increase in taurine (Tau) in patients. The NP results indicated a significant correlation between motor function assessed by NP tests and mI ratios recorded using two-dimensional L-COSY. Conclusion The study demonstrated the feasibility of evaluating the two-dimensional L-COSY sequence in a clinical environment. The results showed additional cerebral metabolites that can be measured with the technique in comparison to one-dimensional study. J. Magn. Reson. Imaging 2005;21:398,405. © 2005 Wiley-Liss, Inc. [source] Methodology of oral sensory testsJOURNAL OF ORAL REHABILITATION, Issue 8 2002R. Jacobs Summary Different methods of oral sensory tests including light touch sensation, two-point discrimination, vibrotactile function and thermal sensation were compared. Healthy subjects were tested to assess the results obtained from two psychophysical approaches, namely the staircase and the ascending & descending method of limits for light touch sensation and two-point discrimination. Both methods appeared to be reliable for examining oral sensory function. The effect of topical anaesthesia was also evaluated but no conclusion could be drawn as too few subjects were involved. Newly developed simple testing tools for two-point discrimination and thermal sensation in a clinical situation were developed prior to this study and tested for their reproducibility. Thermal sensation could be reliably detected in repeated trials. Although the hand-held instruments have some drawbacks, the outcome of these instruments in a clinical environment is suitable for assessing oral sensory function. Three different frequencies (32, 128 and 256 Hz) were used to estimate the vibrotactile function. Different threshold levels were found at different frequencies. [source] Empirical evidence for symbiotic medical education: a comparative analysis of community and tertiary-based programmesMEDICAL EDUCATION, Issue 2 2006Paul Worley Background, Flinders University has developed the Parallel Rural Community Curriculum (PRCC), a full year clinical curriculum based in rural general practice in South Australia. The examination performance of students on this course has been shown to be higher than that of their tertiary hospital-based peers. Aim, To compare the learning experiences of students in the community-based programme with those of students in the tertiary hospital in order to explain these improved academic outcomes. Method, A case study was undertaken, using an interpretivist perspective, with 3 structured interviews carried out over 2 academic years with each of 6 students from the community-based programme and 16 students from the tertiary hospital. The taped interviews were transcribed and analysed thematically using nud*ist software. Results, The community-based programme was successful in immersing the students in the clinical environment in a meaningful way. Four key themes were found in the data. These represented clear differences between the experiences of the community-based and hospital-based students. These differences involved: the value that students perceived they were given by supervising doctors and their patients; the extent to which the student's presence realised a synergy between the work of the university and the health service; opportunities for students to meet the aspirations of both the community and government policy, and opportunities for students to learn how professional expectations can mesh with their own personal values. Conclusion, This study has provided empirical evidence for the importance of the concept of symbiosis in understanding quality in medical education. [source] The Utility of Simulation in Medical Education: What Is the Evidence?MOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 4 2009Yasuharu Okuda MD Abstract Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes. Mt Sinai J Med 76:330,343, 2009. © 2008 Mount Sinai School of Medicine [source] Meeting patient needs in the hospital setting, are written nutrition education resources too hard to understand?NUTRITION & DIETETICS, Issue 3 2008Louise PERKINS Abstract Aims:, To determine the readability of written nutrition education resources currently used in the Nutrition and Dietetics Department in a large teaching hospital and assess whether these resources are of an appropriate readability level for the target population. Methods:, Dietitians in the department (n = 17) were interviewed to identify resources in use. Readability analysis of current resources (n = 235) followed, using the Simplified Measure of Gobbledegook (SMOG). The SMOG scores were compared with census data for the average reading ability of the target population based on the number of school years completed. Results:, The readability level for the resources ranged from 6 to 15. The mean was 10.4 ± 1.89 (n = 235). This compared with a reading ability in the target population of between years 6 and 8. This discrepancy suggests that the resources may be too complex and are unlikely to be well understood by the target population. Conclusions:, In the time-poor clinical environment where there is reliance on written nutrition resources to support and reinforce education messages, it is pertinent to pay more attention to readability level. Written resources are unlikely to be effective if they are too complex. It is therefore suggested that dietitians consider the readability when developing and reviewing written nutrition education resources to ensure best-quality patient care. The results of this project suggest that the SMOG index is a useful method to use for this purpose as it is widely available, easy to use and expedient in implementation. [source] Resident Training in Emergency Ultrasound: Consensus Recommendations from the 2008 Council of Emergency Medicine Residency Directors ConferenceACADEMIC EMERGENCY MEDICINE, Issue 2009Saadia Akhtar MD Abstract Over the past 25 years, research performed by emergency physicians (EPs) demonstrates that bedside ultrasound (US) can improve the care of emergency department (ED) patients. At the request of the Council of Emergency Medicine Residency Directors (CORD), leaders in the field of emergency medicine (EM) US met to delineate in consensus fashion the model "US curriculum" for EM residency training programs. The goal of this article is to provide a framework for providing US education to EM residents. These guidelines should serve as a foundation for the growth of resident education in EM US. The intent of these guidelines is to provide minimum education standards for all EM residency programs to refer to when establishing an EUS training program. The document focuses on US curriculum, US education, and competency assessment. The use of US in the management of critically ill patients will improve patient care and thus should be viewed as a required skill set for all future graduating EM residents. The authors consider EUS skills critical to the development of an emergency physician, and a minimum skill set should be mandatory for all graduating EM residents. The US education provided to EM residents should be structured to allow residents to incorporate US into daily clinical practice. Image acquisition and interpretation alone are insufficient. The ability to integrate findings with patient care and apply them in a busy clinical environment should be stressed. [source] Attending and Resident Satisfaction with Feedback in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 2009Lalena M Yarris MD Abstract Objectives:, Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED. Methods:, This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses. Results:, Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001). Conclusions:, Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED. [source] Validation of a novel fibreoptic intubation trainerANAESTHESIA, Issue 1 2010D. J. Williams Summary The aim of this study was to validate a novel inexpensive training device as a means of improving the psychomotor skills involved in the manipulation of a fibreoptic endoscope. Seventy-five subjects attempted to pass a fibreoptic endoscope through the device five times, with each attempt timed to the nearest second. Although prior clinical experience of fibreoptic intubation was associated with better performance, all groups showed improvement with each attempt. Qualitative feedback indicated that the device required subjects to use similar skills to those used in clinical practice. This study supports the use of such a device in training and assessment although further studies will be required to determine whether the skills learned on the device can be transferred to the clinical environment. [source] Gas embolism: pathophysiology and treatmentCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2003Robert A. van Hulst Summary Based on a literature search, an overview is presented of the pathophysiology of venous and arterial gas embolism in the experimental and clinical environment, as well as the relevance and aims of diagnostics and treatment of gas embolism. The review starts with a few historical observations and then addresses venous air embolism by discussing pulmonary vascular filtration, entrapment, and the clinical occurrence of venous air emboli. The section on arterial gas embolism deals with the main mechanisms involved, coronary and cerebral air embolism (CAE), and the effects of bubbles on the blood,brain barrier. The diagnosis of CAE uses various techniques including ultrasound, perioperative monitoring, computed tomography, brain magnetic resonance imaging and other modalities. The section on therapy starts by addressing the primary treatment goals and the roles of adequate oxygenation and ventilation. Then the rationale for hyperbaric oxygen as a therapy for CAE based on its physiological mode of action is discussed, as well as some aspects of adjuvant drug therapy. A few animal studies are presented, which emphasize the importance of the timing of therapy, and the outcome of patients with air embolism (including clinical patients, divers and submariners) is described. [source] Performance of Five Commercially Available Tooth Color-Measuring DevicesJOURNAL OF PROSTHODONTICS, Issue 2 2007Alma Dozi Purpose: Visual tooth color assessment is neither accurate nor precise due to various subjective and objective factors. As newly developed tooth color-measuring devices for dental application provide the possibility of a more objective means of color determination, their performances in vitro and in vivo must be evaluated. The objective of this study was to evaluate the accuracy and precision of five commercially available tooth color-measuring devices in standardized and in clinical environments. Materials and Methods: In an in vitro study, standards (A1, A2, A3, A3.5, and A4 shade tabs of Vita Lumin) were measured five times with five electronic devices (ShadeScan, Easyshade, Ikam, IdentaColor II, and ShadeEye) by two operators. In an in vivo study, the right upper central incisors of 25 dental students were measured with the same electronic devices by a single operator. Vita shade tab codes were expressed as CIE (International Commission on Illumination) L*a*b* values and in terms of the precision and accuracy of ,E color differences. The Mann-Whitney statistical test was used to analyze the differences between the two operators in the in vitro study, and the Kruskal-Wallis one-way analysis of variance on ranks with the post-hoc Tukey test was used to analyze the accuracy and precision of electronic devices. Results: No statistically significant difference was found between the different operators in the in vitro study. The obtained precision was Easyshade > ShadeScan , Ikam > IdentaColor II > ShadeEye. The obtained accuracy was Easyshade > ShadeScan , Ikam > ShadeEye > IdentaColor II. In the in vivo study, the Easyshade and the Ikam were the most precise, and the ShadeEye and the IdentaColor II were more precise than the ShadeScan. With respect to accuracy, there was no statistical difference between the ShadeScan, Ikam, and the Easyshade. The IdentaColor II was considered inaccurate (,Ea= 3.4). Conclusions: In the clinical setting, the Easyshade and Ikam systems were the most reliable. The other devices tested were more reliable in vitro than in vivo. [source] Multichannel mapping of fetal magnetocardiogram in an unshielded hospital settingPRENATAL DIAGNOSIS, Issue 5 2005Donatella Brisinda Abstract Objectives To evaluate the feasibility of unshielded in-hospital multichannel mapping of fetal magnetocardiogram (FMCG), with a 36-channel system for standard adult magnetocardiographic (MCG) recordings, and its reliability according to the recommended standards for FMCG. Methods FMCG was ambulatory mapped with a 36-channel MCG system, in six normal pregnancies at different gestational ages. MCG analysis included adaptive digital filtering of 50 Hz, signal averaging, reconstruction of magnetic field distribution (MFD) and source localization. Fixed Point Independent Component Analysis algorithm (FastICA) was used to reconstruct the FMCG, separating them from maternal contamination and noise. Results The quality of FMCG recorded after the 32nd gestational week and reconstructed with FastICA was close to FMCG obtained in shielded rooms, and good enough to measure cardiac intervals and heart rate variability parameters. In two cases, reconstruction of the MFD during the QRS allowed three-dimensional localization of ventricular sources. Conclusions A first demonstration has been given that multichannel mapping of FMCG can be performed in unshielded clinical environments, with resolution good enough for contactless assessment of fetal cardiac electrophysiology. FastICA processing on unshielded FMCG, recorded after the 32nd week, provided beat-to-beat analysis and heart rate variability assessment. Further work is needed to improve signal reconstruction in early pregnancy. Copyright © 2005 John Wiley & Sons, Ltd. [source] The Effect of Emergency Department Crowding on Education: Blessing or Curse?ACADEMIC EMERGENCY MEDICINE, Issue 1 2009Philip Shayne MD Abstract Emergency department (ED) crowding is a national crisis that contributes to medical error and system inefficiencies. There is a natural concern that crowding may also adversely affect undergraduate and graduate emergency medicine (EM) education. ED crowding stems from a myriad of factors, and individually these factors can present both challenges and opportunities for education. Review of the medical literature demonstrates a small body of evidence that education can flourish in difficult clinical environments where faculty have a high clinical load and to date does not support a direct deleterious effect of crowding on education. To provide a theoretical framework for discussing the impact of crowding on education, the authors present a conceptual model of the effect of ED crowding on education and review possible positive and negative effects on each of the six recognized Accreditation Council for Graduate Medical Education (ACGME) core competencies. [source] Educational and Research Implications of Portable Human Patient Simulation in Acute Care MedicineACADEMIC EMERGENCY MEDICINE, Issue 11 2008Leo Kobayashi MD Abstract Advanced medical simulation has become widespread. One development, the adaptation of simulation techniques and manikin technologies for portable operation, is starting to impact the training of personnel in acute care fields such as emergency medicine (EM) and trauma surgery. Unencumbered by cables and wires, portable simulation programs mitigate several limitations of traditional (nonportable) simulation and introduce new approaches to acute care education and research. Portable simulation is already conducted across multiple specialties and disciplines. In situ medical simulations are those carried out within actual clinical environments, while off-site portable simulations take place outside of clinical practice settings. Mobile simulation systems feature functionality while moving between locations; progressive simulations are longer-duration events using mobile simulations that follow a simulated patient through sequential care environments. All of these variants have direct applications for acute care medicine. Unique training and investigative opportunities are created by portable simulation through four characteristics: 1) enhancement of experiential learning by reframing training inside clinical care environments, 2) improving simulation accessibility through delivery of training to learner locations, 3) capitalizing on existing care environments to maximize simulation realism, and 4) provision of improved training capabilities for providers in specialized fields. Research agendas in acute care medicine are expanded via portable simulation's introduction of novel topics, new perspectives, and innovative methodologies. Presenting opportunities and challenges, portable simulation represents an evolutionary progression in medical simulation. The use of portable manikins and associated techniques may increasingly complement established instructional measures and research programs at acute care institutions and simulation centers. [source] | |||||||||||||