Characterization of skin blebs from intradermal jet injection: Ex-vivo studies.

This paper presents results from an ex-vivo study of intradermal jet injections, which is an attractive method to achieve both needle-free and fractional dose delivery of vaccines. Due to the fact that fluid properties of many novel therapeutics and vaccines can vary significantly, a key parameter for our study is the fluid viscosity, whilst the main focus is on determining the best correlation between the delivered volume and geometrical dimensions of the fluid deposit. For this we use a combination of top-view (skin wheal), underside (below the dermis), and cross-section (true skin bleb) perspectives and find that the top-view alone, as done in clinical practice, is insufficient to estimate the volume deposited in the dermis. Overall, the best correlation is found between the injection volume and cross-sectional diameter, however there is significant variation amongst the different fluids. For mean injection volumes of 60 µL the mean bleb diameter is ≈8 mm, with mean aspect ratio h¯/d=0.38, indicating the blebs are mostly oblate. However, the shape varies with viscosity and the higher viscosity does not spread laterally to the same degree as lower viscosity fluids. In addition, our high-speed video observations of the injection process, reveal some interesting dynamics of the jet injection method, and we modeled the bleb growth with an exponential saturation.

Teaching professionalism to first year medical students using video clips.

BACKGROUND: Medical schools are confronted with the challenge of teaching professionalism during medical training. The aim of this study was to examine medical students' perceptions of using video clips as a beneficial teaching tool to learn professionalism and other aspects of physicianship. METHODS: As part of the longitudinal Physician Apprenticeship course at McGill University, first year medical students viewed video clips from the television series ER. The study used qualitative description and thematic analysis to interpret responses to questionnaires, which explored the educational merits of this exercise. RESULTS: Completed questionnaires were submitted by 112 students from 21 small groups. A major theme concerned the students' perceptions of the utility of video clips as a teaching tool, and consisted of comments organized into 10 categories: "authenticity and believability", "thought provoking", "skills and approaches", "setting", "medium", "level of training", "mentorship", "experiential learning", "effectiveness" and "relevance to practice". Another major theme reflected the qualities of physicianship portrayed in video clips, and included seven categories: "patient-centeredness", "communication", "physician-patient relationship", "professionalism", "ethical behavior", "interprofessional practice" and "mentorship". CONCLUSIONS: This study demonstrated that students perceived the value of using video clips from a television series as a means of teaching professionalism and other aspects of physicianship.

Doing the "talk": disclosure of a diagnosis of cerebral palsy.

The disclosure to a family of a child's cerebral palsy is an important transformative event that has potential lasting implications. This article highlights specific challenges, the results of research into the disclosure process and what attributes should be sought for in this encounter by health care providers. Illustrative case vignettes are presented to concretely demonstrate the "dos and don'ts" of the disclosure. Suggestions will also be provided to improve the disclosure process.