Treating Children With Physical Disabilities: A Video-Based Educational Resource Using Simulated Participants.

OBJECTIVES: Children with physical disabilities (CWPD) have historically experienced inadequate and insensitive care across medical settings. A lack of comfort and knowledge about CWPD is prevalent among healthcare provider trainees. We developed a new, readily distributable educational resource about CWPD for healthcare students and conducted a study to determine its efficacy in improving their attitudes toward CWPD. METHODS: We collaborated with a working group of stakeholders in the disability community to develop an educational resource for healthcare students. We developed nine short video clips (with a cumulative duration of 27 min) of a primary care visit using simulated participants and embedded them into a 50-min workshop. We conducted a study of the workshop's utility for volunteer healthcare students using synchronous videoconferencing. Participating students completed assessments at baseline and after the workshop. Our primary outcome measure was a change in the Attitudes to Disabled Persons-Original (ATDP-O) scale. RESULTS: Forty-nine healthcare students participated in the training session: 29 (59%) from medicine, and 21 (41%) from physician assistant or nursing programs. The materials were easy to deliver virtually. The workshop resulted in measurable change in attitudes regarding physical disabilities, with improvement in ATDP-O scores between baseline (M = 31.2, SD = 8.9) and endpoint (M = 34.8, SD = 10.1) scores (t (49)= 3.28, P = .002, Cohen's d = 0.38). CONCLUSION: This video-based educational resource on CWPD is readily distributable and can be delivered virtually as a workshop. The video-enhanced workshop improved healthcare students' perceptions and attitudes toward CWPDs. All materials are available to view, download, or adapt by end-use instructors.

Are Medical Students Adequately Trained to Care for Persons With Disabilities?

Background and Objectives: Insufficient provider training contributes to health care disparities for 61 million Americans with disabilities.2,4 This study examines medical students' perceptions of their disability training and the perceived effect training has on students' preparedness to care for people with disabilities (PWD) in future practice. Methods: Principles of the Core Competencies on Disability for Health Care Education5 generated 10 questions. The questions were included in a survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) and sent to medical student members of the American Academy of Family Physicians (AAFP). We compared responses using unadjusted χ2 tests. Results: One hundred forty-seven surveys were returned, with 126 used for this analysis; 36% of students reported that their medical training provided them with the knowledge necessary to provide high-quality, comprehensive health care for PWD in their future practice and 97.6% agreed or strongly agreed that they needed to learn more. Six of the curricular exposures demonstrating variations of the health care needs of PWD were associated with higher percentages of medical students agreeing they are trained to perform high-quality health care for PWD in future practice. Conclusion: Medical students continue to report deficiencies in training, knowledge, and preparedness to care for PWD. Based on the Core Competencies framework, we have identified six curricular exposures that increase readiness to care for PWD. Therefore, we recommend the Liaison Committee on Medical Education formally integrate requirements for disability training in the standards of accreditation.7.

Call to Action: Eliminate Barriers Faced by Medical Students With Disabilities.

When physicians have a disability or chronic condition, they can offer deeper insight and ability into managing the needs of patients with similar conditions. Yet an alarming 2021 survey found that only 40.7% of physicians feel confident that they provide the same level of care to people with disabilities (PWD) as those without. This may contribute to troubling health care disparities for the over 61 million Americans living with disabilities. In a recent report, The American Medical Association (AMA) recognized that increased concordance between patients and physicians with disabilities is key to resolving health care inequities for PWD, yet although 1 in 5 patients reports a disability, only 1 in 33 physicians identifies as such. This is because prospective medical students with disabilities face many barriers in medical education and practice. We call for specific changes to medical school admission processes and curricula to promote a more just and diverse workforce which includes more physicians with disabilities.

Addressing Common Questions About Traveling by Air After Orthopedic Surgery.

Many patients have questions about traveling by air after orthopedic surgery. The goal of this review was to provide a guide to addressing these issues to better prepare patients for air travel. A comprehensive literature review was conducted to address patient questions regarding metal detectors, as well as deep venous thrombosis risk with flying. Further, patient questions pertaining to specific airlines, airports, and Transportation Security Administration policies were answered through direct discussion with representatives, website review, and internet research. Ultimately, providers should be aware of the many challenges that orthopedic patients face during air travel, and patients should consult their providers before making travel plans. Airline passengers are likewise encouraged to equip themselves with the information presented in this article, to best advocate for themselves. This guide should be used as a reference tool, providing up-to-date information about air travel after orthopedic surgery to both patients and providers alike. [Orthopedics. 2021;44(6):e719-e723.].

Latissimus dorsi detrusor myoplasty for bladder acontractility: a systematic review.

Bladder acontractility affects several thousand patients in the United States, but the available therapies are limited. Latissimus dorsi detrusor myoplasty (LDDM) is a therapeutic option that allows patients with bladder acontractility to void voluntarily. Our goal was to conduct a systematic review of the literature to determine whether LDDM is a better option than clean intermittent catheterization (CIC) (standard treatment) in patients with bladder acontractility. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases, without time frame limitations, to identify articles on the use of LDDM for bladder acontractility. Of 75 potential articles, 4 fulfilled the eligibility criteria. The use of LDDM to treat patients with bladder acontractility was reported in four case series by the same group in Europe. Fifty-eight patients were included, and no comparison groups were included. The most common cause of bladder acontractility was spinal cord injury (n=36). The mean (±standard deviation) operative time was 536 (±22) minutes, postoperative length of hospital stay ranged from 10 to 13 days, and follow-up ranged from 9 to 68 months. Most patients had complete response, were able to void voluntarily, and had post-void residual volume less than 100 mL. Although promising outcomes have been obtained, evidence is still weak regarding whether LDDM is better than CIC to avoid impairment of the urinary tract among patients with bladder acontractility. Further prospective studies with control groups are necessary.

Experimental Studies of Latissimus Dorsi Detrusor Myoplasty for Bladder Acontractility: A Systematic Review.

Current therapies that allow patients with bladder acontractility to void are limited. The standard therapy is clean intermittent catheterization. Latissimus dorsi detrusor myoplasty (LDDM) has been shown to provide functional contraction and allow patients with bladder acontractility to void voluntarily. Our goal was to summarize experimental studies of LDDM. We hypothesized that experimental studies would show that latissimus dorsi muscle (LDM) flaps for detrusor myoplasty have superior outcomes when compared with other types of flaps. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, and EMBASE databases, without time frame limitations, to identify articles on the use of LDDM. We excluded studies that investigated other treatments. Of 54 articles identified by the search, three fulfilled the eligibility criteria. A total of 24 dogs underwent procedures and were evaluated with a maximum follow-up of 9 months. Three types of procedures were performed: LDM in situ reconfiguration, LDM myoplasty, and augmentation cystoplasty after supratrigonal cystectomy. Electrical stimulation, cystography, urodynamic and hydrodynamic measurements, and microscopic examinations were performed. Innervated LDM flaps transferred to the bladder were able to contract and promote voiding in response to electrical stimulation. Experimental studies have shown the feasibility of LDDM in canine models. Although no comparison groups were included, innervated LDM flap transferred to the bladder showed promising results regarding contraction capable of voiding.

Subclavian venipuncture following ipsilateral extrapleural dissection is hazardous.

Subclavian artery puncture is an infrequent complication of subclavian vein cannulation. In spite of the limited ability to apply direct pressure to the bleeding vessel, significant hematoma or exsanguinating bleeding rarely occurs. This study was a retrospective chart review of a neonate who underwent extrapleural repair of a tracheo-esophageal fistula and sustained significant blood loss following an accidental ipsilateral subclavian artery puncture. This case highlights the importance of an intact apical pleura in controlling bleeding from the subclavian vessels. Thus, ipsilateral percutaneous subclavian venipuncture should be avoided in patients in whom the apical pleura is not intact.