Search

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018-2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks - adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019-2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

Purpose: There are limited school physical activity policy dissemination and implementation studies. This is a concern given the adverse mental, physical, and socio-emotional effects the COVID-19 pandemic has had on children and adolescents. This study explored New Jersey school administrators' experiences in disseminating recess guidelines, procedures, and policies as well as implementation strategies in their schools during the pandemic. Methods: A total of 29 elementary school administrators participated in semi-structured interviews. The data were analyzed inductively using a conventional approach to qualitative content analysis. Results: In analyzing the data, five themes were identified: (a) adjustments for recess, (b) communications about recess, (c) successes and challenges of recess, (d) health and well-being among children, and (e) recommendations for recess postpandemic. Discussion/Conclusion: When planning, organizing, and implementing a recess in a postpandemic era, school leaders may want to consider establishing cohorts, developing a handbook, creating a rotation schedule (i.e., blacktop, field, playground), developing a recess committee, utilizing the physical education teacher for staff development, assigning recess equipment and bags, offering a variety of activities, and teaching children how to play. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. Methods: A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. Results: 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. Conclusion: Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates. [ABSTRACT FROM AUTHOR]

As end-stage renal disease becomes more prevalent in the United States, the number of Americans with arteriovenous (AV) fistulas continues to increase. One of the most feared complications of AV fistulas is life-threatening hemorrhage, as patients can exsanguinate within minutes. As frontline healthcare workers, emergency medicine (EM) providers need to be able to provide rapid and effective treatment for this rare presentation. We developed a task trainer model to simulate AV fistula hemorrhage to prepare and train EM residents. This task trainer model was constructed with readily available materials and takes about 30 minutes to make. Twenty-one EM residents participated in the training session. The session consisted of a brief didactic on AV fistula hemorrhage control followed by hands on usage of the task-trainer model. The participants filled out an anonymous survey afterwards rating the model. Residents completed anonymous postcourse surveys rating the session on a five-point Likert scale. Both the overall teaching session and the task trainer were rated very highly. Compared to precourse ratings, residents reported statistically significant postcourse improvements in their level of confidence in managing AV fistula hemorrhage. To our knowledge, this is the first published task trainer model to simulate a bleeding AV fistula for EM residents. The model was well received by our trainees, is relatively inexpensive, and made from easily sourced materials. We believe this model can be used for trainees of all disciplines to prepare them for this potentially catastrophic patient presentation. [ABSTRACT FROM AUTHOR]

In the dynamic field of healthcare, clinical coding plays a key role in providing accurate and comprehensive information about patients' illnesses and their treatment as part of a comprehensive medical service. Coding systems are now part of health information systems across Europe. Much of what is known about the extent of prevalence, causes and consequences of human disease and mortality worldwide is based on the use of data coded according to the International Classification of Diseases (ICD). The ICD is the world's standard methodology for collecting mortality and morbidity data. The analysis of the available literature on the selected issues outlines the multidimensional role of coding systems in health care, which has a huge impact on decisionmaking in the process of providing medical services. In Bulgaria, despite the abundance of literary sources in the native medical literature, there is still a lack of a comprehensive analysis dedicated specifically to the importance of clinical coding. Regardless of what coding system in a country is used, it is important that medical institutions are trained and know how to record full and precise information about diagnoses and procedures. In this regard, a survey and analysis was conducted in various medical institutions within 6 months in 2023 among staff dealing with clinical coding in medical institutions: doctors, health care professionals, coders and others. The study focused on organization and training in clinical coding, with the aim of highlighting the key elements that contribute to the high degree of accuracy and efficiency in this important medical process. By analyzing the various aspects related to professionalism, training, and internal structures of medical institutions, the study seeks to reveal the inevitable relationship between well-organized and trained coding and increased quality of health care [ABSTRACT FROM AUTHOR]

Preparing and serving allergen-free meals continue to be challenging for food service establishments due to the associated costs and complexity of menu items. Our study assessed food allergy policies and procedures in independently owned restaurants (n = 103) within the Orlando metropolitan area in Florida. The Florida Department of Business and Professional Regulation HR 5030-038 from the Division of Hotels and Restaurants requires all food service managers and employees to know and name the top 8 major allergens and describe common food allergy symptoms. In total, 71 restaurants accommodated customers who have food allergies. Further, 25 restaurants reported having written food allergy policies and procedures, 63 did not, and 5 did not know. Approximately one half (49) of the owners, operators, and managers did not receive food allergy training. Of the training provided, 27 restaurants offered training in English and 20 restaurants offered training also in Spanish. Food service establishments will benefit from developing and implementing food allergy policies and procedures to serve food safely to customers who have food allergies. [ABSTRACT FROM AUTHOR]

Penile skin zipper entrapment is an emergent medical condition in which the penile skin, scrotal skin, or foreskin gets caught within the teeth of a zipper or the slider itself. This can lead to complications such as urethral involvement, skin loss, or tissue necrosis. We propose a novel technique to aid in the release of entrapped skin utilizing wire cutters directed at the inferior portion of the zipper pull. To describe a novel technique to free entrapped penile skin and compare its performance to the well-established median bar technique in a simulated setting. A randomized cross-over design was used to compare techniques on successful release, time to release and tissue injury using an animal model of raw chicken skin entrapped in a zipper. Statistical significance was assessed at p < 0.05. Twenty-two participants were included. There was no statistically significant difference between the novel technique and the median bar technique regarding successful release (100% vs 95.5%, respectively), median time to release (29.1 vs 26.4 seconds, respectively), or frequency of tissue injury (22.7% vs 27.3%). Performance using our novel technique for removal of penile skin from a zipper is similar to the median bar release technique regarding. Our novel technique may be a valid treatment option for the release of entrapped penile skin in a zipper mechanism in the emergency department setting. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC). Background: Although ATV is a hard criterion for TC verification, importance of procedural interventions as a potential quality indicator is understudied. Methods: Patients managed at ACS level I TCs were identified from ACS-TQIP 2017--2021. TCs were identified using facility keys and stratified into quartiles based on ATV into low, low-medium, medium-high, and high volume. TCs were also stratified into tertiles [low (LV), medium (MV), high (HV)] based on procedural volume by assessing annual number of laparotomies, thoracotomies, craniotomies/ craniectomies, angioembolizations, vascular repairs, and long bone fixations performed at each center. The Cohen κ statistic was used to assess concordance between ATV and procedural volume. Results: A total of 182 Level I TCs were identified: 76 low, 47 lowmedium, 35 high-medium, and 24 high volume. Long bone fixation, laparotomy, and craniotomy/craniectomy were the most performed procedures with a median of 65, 59, and 46 cases/center/year, respectively. Overall, 31% of HV laparotomy centers, 31% of HV thoracotomy centers, 22% of HV craniotomy/craniectomy centers, 22% of HV vascular repair centers, 32% of HV long bone fixation centers, and 33% of HV angioembolization centers contributed to the overall number of low-medium and low-volume TCs. The Cohen κ statistic demonstrated poor concordance between ATV and procedural volumes for all procedures (overall procedural volume--κ=0.378, laparotomy--κ=0.270, thoracotomy--κ=0.202, craniotomy/craniectomy--κ=0.394, vascular repair--κ=0.298, long bone fixation--κ=0.277, angioembolization--κ=0.286). Conclusions: ATV does not reflect the procedural interventions performed. Combination of procedural and ATV may provide a more accurate picture of the clinical experience at any given TC. [ABSTRACT FROM AUTHOR]

This article presents research on the scale of the phenomenon of sexual violence against students at selected 33 universities across Poland, the mechanisms used to combat the problem and the awareness of students on the subject. The study focuses on the practical dimension of combating sexual violence against students in the Polish academic environment. It looks at the existence and functioning of both specialised bodies and the procedures used to help the victims and punish the perpetrators. Additionally, the paper describes how the diversity of available legal measures to address the problem by both helping the victims and holding perpetrators accountable creates the issue of the coexistence of two systems—criminal and intra-university. Presenting preliminary results of gathered opinions of universities' officials regarding functioning of the bodies specialised in combating sexual violence shows not only the most dominant observations and conclusions the professionals have regarding the functions they hold at their home universities, but also main challenges that have to be considered in both creating sufficient policies in order to deal with sexual violence and conducting comprehensive research on said phenomenon. [ABSTRACT FROM AUTHOR]

The introduction of dual-energy X-ray absorptiometry (DXA) technology in the 1980s revolutionized the diagnosis, management and monitoring of osteoporosis, providing a clinical tool which is now available worldwide. However, DXA measurements are influenced by many technical factors, including the quality control procedures for the instrument, positioning of the patient, and approach to analysis. Reporting of DXA results may be confounded by factors such as selection of reference ranges for T-scores and Z-scores, as well as inadequate knowledge of current standards for interpretation. These points are addressed at length in many international guidelines but are not always easily assimilated by practising clinicians and technicians. Our aim in this report is to identify key elements pertaining to the use of DXA in clinical practice, considering both technical and clinical aspects. Here, we discuss technical aspects of DXA procedures, approaches to interpretation and integration into clinical practice, and the use of non-bone mineral density measurements, such as a vertebral fracture assessment, in clinical risk assessment. [ABSTRACT FROM AUTHOR]

The role of wound debridement in pyoderma gangrenosum (PG) is controversial, largely due to concerns regarding pathergy. This study sought to evaluate the clinical outcomes and utility of wound debridement in PG management. We conducted a retrospective cohort study of 104 patients diagnosed with PG at a single tertiary referral centre, stratified into two treatment groups: those receiving debridement in conjunction with immunosuppressive therapy (n = 38) and those treated with immunosuppression alone (control group, n = 66). The primary outcomes measured were remission (absence of active PG lesions without necessitating additional treatment), time to remission and disease progression (new lesions or expansion of existing ones). Remission was achieved by 60.53% (n = 23) in the debridement group versus 87.88% (n = 58) in the control group (p = 0.003). The mean time to remission was 12.3 months for the debridement group versus 8.67 months for the control group (p = 0.2). Multivariate Cox regression analysis indicated that debridement significantly decreased the likelihood of disease remission (adjusted hazards ratio [HR]: 0.45, 95% confidence interval [CI]: 0.26–0.78, p = 0.005). Disease progression was significantly higher in the debridement group (68.42%, n = 26) compared to the control group (15.15%, n = 10) (p < 0.001). Additionally, 28.95% (n = 11) of patients in the debridement group required repeated procedures, and 10.53% (n = 4) underwent amputations due to deteriorating conditions. The timing and duration of immunosuppressive therapy relative to the procedure did not mitigate the risk of post‐surgical exacerbations. These findings suggest that debridement is associated with poorer healing outcomes in PG, advocating for its contraindication in the management of this condition. [ABSTRACT FROM AUTHOR]

Pseudothrombocytopenia (PTCP) is defined by the occurence of spouriously low platelet count as a consequence of in vitro platelet aggregation. It is a rare and benign artifact, not associated with any specific disorder or therapy, that becomes clinically relevant when it is not timely and reliably recognized. Thus, it may result in inappropriate clinical decisions (i.e. unnecessary further testing, misdiagnoses and potential patients' mismanagement) unavoidably compromising patient safety. The most common form of PTCP is caused by ethylenediaminetetraacetic acid (EDTA). Several approaches for the management of samples with EDTA-induced PTCP have been described in the literature. However, expert recommendations are scarce. The scope of these recommendations is to assist in achieving national harmonisation in laboratory management (i.e. detecting and reporting platelet counts) of samples with EDTA-induced PTCP. These minimal recommendations were prepared by the members of the joint working group of the Croatian Chamber of Medical Biochemists and Working group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, and might be customized according to specific conditions (i.e. personnel and equipment) of each individual laboratory. These recommendations are primarily intended to all laboratory professionals involved in the management of samples with EDTA-induced PTCP, but also to other healthcare professionals involved in collecting samples and interpreting complete blood count results. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine the status of the transitional period and its implications for the "reconciliation and amnesty" mechanisms found in nations with transitional laws. These mechanisms are typically included in the transitional phase that results from drastically and completely altering a country's political system. The state uses a variety of mechanisms and strategies to integrate equity during times of systemic transition or transformation. In our research, we examine extrajudicial mechanisms like "reconciliation," victim compensation programs, and amnesty linked to community reconciliation in comparison to the dominant mechanisms of transitional constitutional systems to arrive at a conclusion regarding the relative importance or value of each. We also attempt to highlight the advantages or disadvantages of including these provisions or system in that mechanism and offer conclusions and recommendations targeted at addressing or evaluating that inclusion. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigated availability of teaching facilities and utilization of instructional procedures for implementation of Chemistry core curriculum (CCC) in senior secondary schools (SSS) in Ebonyi State. Specifically, it determined level of availability of stipulated facilities and extent of utilization of instructional procedures by teachers for implementation of CCC in SSS in Ebonyi State. Design of the study was descriptive survey. Population was made up of all 216 senior secondary schools in Ebonyi State. Proportionate random sampling was used to draw a sample of 120 schools. Chemistry teachers and laboratory attendants participated in the study. Instruments for data collection were checklist and questionnaire. Results show that good examination halls, chalk board and classrooms were 100% very highly available, standard Chemistry laboratory(16%), projector(16%), chemicals and reagents(14%), water and electricity(33% each) were lowly available. Utilization of lecture and laboratory instructional procedures (IP) was of a very high extent with a mean of 3.78 and 3.70 respectively, activity based IP 2.98 and project IP has a mean of 2.73. Analogy and programmed IPs were very lowly utilized with a mean of 1.20 and 1.08 respectively. The study recommended among others, that government should make available teaching and learning facilities as stipulated in CCC to secondary schools for better achievement and implementation of the curriculum. [ABSTRACT FROM AUTHOR]

The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series was created in 2014 to address the Free Open Access Medical Education (FOAM) movements decentralized nature and lack of inherent peer review. The AIR series provides a topic-based, curated list of online educational content vetted by academic emergency medicine (EM) faculty that meets individualized interactive instruction criteria for EM trainees. Relevant FOAM resources were identified from the top 50 FOAM websites using the Social Media Index and then scored by EM faculty using a validated instrument to identify the highest quality posts related to a topic. This article reviews FOAM resources pertaining to EM procedures that were labeled as an Approved Instructional Resource or Honorable Mention using the AIR series methodology.

The purpose of the article is to present the impact of legal regulations in the field of sustainable development (ESG) and taxonomies on the course of credit processes in commercial banks. Methodology refers to studies of legal regulations, comparative analysis of cases (case study) and inference. Results of the research show that the implementation of ESG regulations and taxonomies and the adaptation of credit processes in commercial banks will result in structural changes in loan portfolios in the near future while moving away from financing dirty industries towards the green ones. As a result, the financing stream for green assets and those supporting sustainable development will be increased, while the financing of dirty assets will be significantly reduced due to the increase in risks and accompanying costs for customers and banks. It is expected that even if some banks grant loans to finance dirty assets, they will only be short-term loans and will require high servicing costs (commission, margin, legal security, and insurance). This is due to the fact that the portfolio with credit exposures in the so-called dirty industries (mining, construction, trade) will escalate the increase in ESG risk. Such a portfolio with dirty exposures will require banks to secure additional reserve capital to maintain higher general and sector systemic risk buffers. Some banks will completely stop financing assets from dirty industries, which will mean that some of them will be abandoned due to the lack or high costs of their modernization, intensifying the negative socio-economic consequences. The ongoing process of redirecting the financing stream to green assets in banks means that enterprises and households need to take earlier adaptation actions. These include actions against financing constraints in dirty sectors and likely future losses in infrastructure and assets related to them.

ALS is characterized by a highly heterogeneous course, ranging from slow and uncomplicated to rapid progression with severe extra-motor manifestations. This study investigated ALS-related hospitalizations and their connection to clinical aspects, comorbidities, and prognosis. We performed a retrospective cohort study including patients residing in Modena, Italy, newly diagnosed between 2007 and 2017 and followed up until 31 December 2022. Data were obtained from the Emilia Romagna ALS registry, regional hospitals, and medical records. Among the 249 patients, there were 492 hospital admissions, excluding those for diagnostic purposes; 63% of the patients had at least one hospitalization post-diagnosis, with an average stay of 19.90 ± 23.68 days. Younger patients were more likely to be hospitalized multiple times and experienced longer stays (44.23 ± 51.71 days if <65 years; 26.46 ± 36.02 days if older, p < 0.001). Patients who were hospitalized at least once more frequently underwent gastrostomy (64.97%) or non-invasive (66.24%) and invasive (46.50%) ventilation compared to those never hospitalized (21.74%, 31.52%, 13.04%, respectively, p < 0.001 for all). Emergency procedures led to longer hospitalizations (62.84 ± 48.91 days for non-invasive ventilation in emergencies vs. 39.88 ± 46.46 days electively, p = 0.012). Tracheostomy-free survival was not affected by hospitalizations. In conclusion, younger ALS patients undergo frequent and prolonged hospitalizations, especially after emergency interventions, although these do not correlate with reduced survival. [ABSTRACT FROM AUTHOR]

Objective: Using eye tracking technology, this study sought to determine if differences in hazard statement (HS) compliance based on design elements are attributable to attention maintenance (AM). Background: Recent empirical work has demonstrated counter-intuitive findings for HS designs embedded in procedures. Specifically, prevalent HS designs in procedures were associated with lower compliance. Method: The current study utilized eye tracking technology to determine whether participants are attending to HSs differently based on the inclusion or absence of visually distinct HS design elements typically used for consumer products. We used two different designs that previously yielded the largest gap in HS compliance. In a fully-crossed design, 33 participants completed four rounds of tasks using four procedures with embedded HSs. To assess AM, eye tracking was used to measure gaze and fixation duration. Results: The results indicated there are differences in AM between the two designs. The HSs that included elements traditionally considered effective in the consumer products literature elicited lower fixation duration times, and were associated with lower compliance. However, AM did not mediate the design effect on compliance. Conclusions: The study results suggest the design of HSs are impacting individuals as early as the AM stage of the C-HIP model. The absence of HS design-AM-compliance mediation suggests other C-HIP elements more directly explain the HS design-compliance effects. Application: These results provide more evidence that the communication of Health, Environment, and Safety information in procedures may need to be different from those on consumer products, suggesting design efficacy may be task dependent. [ABSTRACT FROM AUTHOR]

Over investigations contribute to escalating health costs driven by multiple factors including physician decisions, patient requests, information overload, technological advances, marketing, hospital management policies, insurance requirements and defensive practices. The reconciliation between knowledge and clinical wisdom while dealing with uncertainties in medicine is the primary way forward through this ethical maze. A case scenario illustrates what pediatricians need to reflect upon while facing decisions on rational investigations to maximize beneficence while being aware of economics of healthcare delivery. [ABSTRACT FROM AUTHOR]

This study aimed to study the educational loss in basic education schools in the Sultanate of Oman: in light of the Corona pandemic (Covid-19), in terms of the roles of school principals, teachers and parents in redressing the losses, in addition to revealing the challenges and proposals that faced schools during the pandemic period. To achieve the objectives of this study, the researcher followed the qualitative research method based on the case study method. The tool consisted of a structured interview that included four open-ended questions for school principals (15) individuals, and a questionnaire that included five open-ended questions for (49) teacher male and female, who were deliberately chosen from basic education schools in Muscat Governorate. The results revealed that among the manifestations of the loss: students’ poor mastery of basic knowledge and skills in basic subjects, and a loss of some learning skills such as (teamwork, communication, critical thinking, and problem-solving). The most important measures taken to address the wastage (enrichment classes - effective teaching strategies - activities and tests - psychological and social support for students), and the challenges included: poor digital infrastructure for schools, challenges related to parents, students and curricula. The most important proposals for addressing wastage from the point of view of school principals and teachers: developing an annual plan to address wastage, strengthening the technical infrastructure of schools, building supportive teaching programs and mechanisms, professional development programs for teachers in the field of technology, strengthening community partnership, and finally the study reached a set of recommendations. [ABSTRACT FROM AUTHOR]

Copyright of Revista Entramado is the property of Universidad Libre Seccional Cali and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Engineering (17264073) is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The shortage of nursing faculty and the scarcity of clinical placements have compelled researchers to investigate innovative solutions for procedural development to bridge the gap between didactic teaching and clinical experiences. This feasibility study uses augmented reality (AR) with Microsoft HoloLens2 and Dynamics 365 Guides to train graduate nursing students on advanced nursing procedures, focusing on lumbar puncture. A convenience sample of 24 nurse practitioner students participated in the study. The System Usability Scale, Acceptability Scale, and Engagement Scale were used to assess participant's experiences and perceptions. The results are positive for the feasibility and acceptance of AR technology for procedural training. Participants found the HoloLens2 device easy to use and showed confidence in its functionality. The step-by-step instructions provided by Microsoft 365 Guides were understandable, useful, and satisfactory. The students reported high levels of engagement and found the AR experience to be helpful and motivating for learning. Faculty time was significantly reduced using the HoloLens2 for procedural training compared to traditional methods. This study demonstrates the potential for AR as an effective and efficient modality for nursing education. The findings support the integration of AR technology to enhance procedural development, address the challenges of limited clinical sites, and provide students with an immersive and self-paced learning experience. Additional studies will need to explore the impact of AR on clinical competency, patient outcomes, and cost-effectiveness. Overall, the use of AR technology may be useful and effective for nursing pedagogy. [ABSTRACT FROM AUTHOR]

Biopsies of muscle and adipose tissue (AT) are useful tools to gain insights into the aging processes in these tissues. However, they are invasive procedures and their risk/benefit profile in older adults can be altered by sarcopenia, frailty, poor healing, and multimorbidity. Their success rates, safety, and tolerability in a geriatric population have not been reported in detail. Investigators in the Study of Muscle, Mobility, and Aging (SOMMA) performed biopsies of muscle and AT in older adults and prospectively collected data on biopsy success rates, safety, and tolerability. We report here the methods and outcomes of these two procedures. In total, 861 participants (aged 70–94) underwent percutaneous biopsies of the Vastus lateralis muscle with a Bergstrom needle. A subset (n = 241) also underwent percutaneous biopsies of the abdominal subcutaneous AT with the tumescent liposuction technique. Success rate was assessed by the percentage of biopsies yielding adequate specimens for analyses; tolerability by pain scores; and safety by frequency of adverse events. All data were prospectively collected. The overall muscle biopsy success rate was 97.1% and was modestly lower in women. The AT biopsy success rate was 95.9% and slightly lower in men. Minimal or no pain was reported in 68% of muscle biopsies and in 83% of AT biopsies. Adverse events occurred in 2.67% of muscle biopsies and 4.15% of AT biopsies. None was serious. In older adults, percutaneous muscle biopsies and abdominal subcutaneous AT biopsies have an excellent safety profile, often achieve adequate tissue yields for analyses, and are well tolerated. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Finance & Financial Law / Finanse i Prawo Finansowe is the property of Wydawnictwo Uniwersytetu Lodzkiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Anbar University for Law & Political Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Starting a new business can sometimes be quite simple and sometimes very challenging. Data from various countries show that this situation varies from region to region. In particular, the setup time and procedures involved in starting a business are important factors that can hinder the business setup process and demotivate entrepreneurs from making a new investment. This study therefore examines the extent to which entrepreneurs are affected by these factors. The research sample includes 10-year data of 87 different countries. It consists of 3 different variables and contains 2610 data in total. The findings demonstrated a positive and significant relationship between business setup time and procedures, a negative and significant relationship between procedures and starting a new business, a negative and significant relationship between business set up time and starting a new business. It was also revealed that procedures have a mediator role on the relationship between business setup time and starting a new business. The results of the study indicate that there should be a global reduction in the time-consuming aspects of business start-up procedures. Addressing these impediments to entrepreneurship and implementing policies that encourage the creation new investment in the economy are important tasks of governments. The research provides quantitative insights to researchers who aim to conduct future studies on this subject. [ABSTRACT FROM AUTHOR]

This article discusses the use of ultrasound guidance in the placement of central venous catheters. The author explains that ultrasound has revolutionized the field by allowing for venipuncture at previously inaccessible sites. The article focuses on the subclavian vein approach and presents a study that compared left and right subclavian access using ultrasound guidance. The study found that left subclavian access had a higher success rate and lower rates of catheter tip malposition. The author suggests that these findings may influence clinical practice and encourage clinicians to consider the infraclavicular subclavian approach. However, the article also acknowledges that further research is needed to fully understand the implications of these findings. [Extracted from the article]

Conceptual and procedural knowledge is fundamental for students to understand and solve fraction problems comprehensively. However, empirical studies indicate that elementary school students still do not have adequate conceptual and procedural knowledge in solving fraction problems. This study aimed to analyze the forms of conceptual and procedural knowledge of elementary school students in solving fraction problems. This study used a qualitative method involving 86 participants from grades four to six in one of the public elementary schools in Sidoarjo. Seven subjects were selected to represent the forms based on each aspect of conceptual and procedural knowledge of fractions. The data analysis used was descriptive analysis with data collection methods using tests, interviews, and documentation. Empirical research showed that students can successfully use conceptual and procedural knowledge of fractions in certain forms. There are three forms of conceptual knowledge of fractions: comparing, applying, and visualizing fractions. Meanwhile, there are four forms of procedural knowledge of fractions: explaining procedures, converting fractions, adding or subtracting fractions, and simplifying fractions. The results of this study have implications for educators or academics to emphasize learning by integrating forms of conceptual and procedural knowledge so that students avoid failure in solving fraction problems. Pengetahuan konseptual dan prosedural merupakan pengetahuan mendasar agar siswa dapat memahami dan memecahkan masalah pecahan secara komprehensif. Namun, berdasarkan studi empiris diindikasikan bahwa siswa sekolah dasar masih belum memiliki pengetahuan konseptual dan prosedural yang memadai dalam memecahkan masalah pecahan. Tujuan penelitian ini untuk menganalisis bentuk-bentuk pengetahuan konseptual dan prosedural siswa sekolah dasar dalam memecahkan masalah pecahan. Penelitian ini menggunakan metode kualitatif dengan melibatkan 86 partisipan siswa kelas empat sampai enam di salah satu sekolah dasar negeri di Sidoarjo. Tujuh subjek dipilih untuk mewakili bentuk-bentuk berdasarkan setiap aspek pengetahuan konseptual dan prosedural pecahan. Analisis data yang digunakan adalah analisis deskriptif dengan metode pengumpulan data menggunakan tes, wawancara dan dokumentasi. Hasil penelitian secara empiris menunjukkan siswa berhasil menggunakan pengetahuan konseptual dan prosedural pecahan dalam bentuk-bentuk tertentu. Terdapat tiga bentuk pengetahuan konseptual pecahan, yaitu: membandingkan pecahan, menerapkan pecahan, dan memvisualisasikan pecahan. Sementara, terdapat empat bentuk pengetahuan prosedural pecahan, yaitu: menjelaskan prosedur, mengkonversi pecahan, menjumlahkan atau mengurangkan pecahan, dan menyederhanakan pecahan. Hasil penelitian ini berimplikasi bagi para pendidik atau akademisi untuk menekankan pembelajaran dengan mengintegrasikan bentuk-bentuk pengetahuan konseptual dan prosedural, agar siswa terhindar dari ketidakberhasilan dalam memecahkan masalah pecahan.

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018–2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks – adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019–2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

Introduction: Hospitalizations during the coronavirus 2019 (COVID-19) pandemic peaked in New York in March–April 2020. In the months following, emergency department (ED) volumes declined. Our objective in this study was to examine the effect of this decline on the procedural experience of emergency medicine (EM) residents compared to the pre-pandemic period.Methods: We conducted this multicenter, retrospective cohort study of patients seen and key procedures performed by EM residents at hospitals spanning three Accreditation Committee for Graduate Medical Education-approved EM residencies in New York City and Nassau County, NY. We obtained numbers of procedures performed during May–July 2020 and compared them to the same time period for 2019 and 2018. We a priori classified critical care procedures—cardioversion, central lines, chest tubes, procedural sedation, and endotracheal intubation. We also studied “fast-track” procedures—fracture/joint reduction, incision and drainage (I&D), laceration repairs, and splints.Results: Total number of critical care procedures in the months following the COVID-19 peak decreased from 694 to 606 (−12.7%, 95% confidence interval [CI] 10.3–15.4%), compared to an increase from 642 to 694 (+8.1%, 95% CI 6.1–10.5%) the previous year (difference −9.3%). Total number of fast-track procedures decreased from 5,253 to 3,369 (−35.9%, 95% CI 34.6–37.2%), compared to a decrease from 5,333 to 5,253 (−1.5%, 95% CI 1.2–1.9%) the year before (difference −36.3%). Specific critical care procedures performed in 2020 compared to the mean of 2019 and 2018 as follows: cardioversion −33.3%; central lines +19.0%; chest tubes −27.9%; procedural sedation −30.8%; endotracheal intubation −13.8%. Specific fast-track procedures: reductions +33.3%; I&D −48.6%; laceration repair −17.3%; and splint application −49.8%.Conclusion: Emergency medicine residents’ critical and fast-track procedural experience at five hospitals was reduced during the months following the COVID-19 peak in comparison to a similar period in the two years prior. Training programs may consider increasing simulation-lab and cadaver-lab experiences, as well as ED and critical care rotations for their residents to offset this trend.

Introduction: Emergency medicine (EM) programs train residents to perform clinical procedures with known iatrogenic risks. Currently, there is no established framework for graduating medical students to demonstrate procedural competency prior to matriculating into residency. Mastery-based learning has demonstrated improved patient-safety outcomes. Incorporation of this framework allows learners to demonstrate procedural competency to a predetermined standard in the simulation laboratory prior to performing invasive procedures on patients in the clinical setting. This study describes the creation and implementation of a competency-based procedural curriculum for first-year EM residents using simulation to prepare learners for supervised participation in procedures during patient care.Methods: Checklists were developed internally for five high-risk procedures (central venous line placement, endotracheal intubation, lumbar puncture, paracentesis, chest tube placement). Performance standards were developed using Mastery-Angoff methods. Minimum passing scores were determined for each procedure. Over a two-year period, 38 residents underwent baseline assessment, deliberate practice, and post-testing against the passing standard score to demonstrate procedural competency in the simulation laboratory during intern orientation.Results: We found that 37% of residents required more than one attempt to achieve the minimum passing score on some procedures, however, all residents ultimately met the competency standard on all five high-risk procedures in simulation. One critical incident of central venous catheter guideline retention was identified in the simulation laboratory during the second year of implementation.Conclusion: All incoming first-year EM residents demonstrated procedural competence on five different procedures using a mastery-based educational framework. A competency-based EM curriculum allowed for demonstration of procedural competence prior to resident participation in supervised clinical patient care.

Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria. An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index. The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%). The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system. [ABSTRACT FROM AUTHOR]