A novel video compendium of real surgical patient interactions for medical students.

Objective: To develop a novel video compendium of real surgical patient interactions as a tool for medical student education and to evaluate our institutional experience of its usefulness. Design: Prospective development of a video compendium of real surgical patient interactions. Setting: Single university affiliated hospital in Cork, Ireland. Participants: Patients with illnesses relevant to the surgery curriculum and students from an Irish medical school. Results: Videos were recorded of the clinical interaction between a consultant surgeon and patients, capturing focused history taking and/or clinical examination, with an associated set of explanatory notes. Fifty videos were developed with a tiered release to the clinical year medical students, via their virtual learning/education platform. Three hundred and eleven students responded to the questionnaire across 3-student year groups (311/585-53 %). Fifty-two percent of students did not have their clinical rotations affected by the COVID-19 pandemic. >90 % of students agreed that the videos helped history taking and clinical examination technique. >80 % of students agreed that the accompanying text slides reinforced key points and helped with understanding difficult topics. Eighty-five percent of students reported that the videos increased exposure to surgical patients and pathology. Eighty-five percent of students rated their experience as at least 4 out of 5. Conclusions: This online educational compendium bridged a gap for students with limited clinical exposure during the COVID-19 pandemic, and has become an important resource for all clinical students. Our novel engagement with real patients sets this compendium apart from resources which use actors.

Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders.

Background: Conflicting reports from varying stakeholders related to prognosis and outcomes following placement of temporomandibular joint (TMJ) implants gave rise to the development of the TMJ Patient-Led RoundTable initiative. Following an assessment of the current availability of data, the RoundTable concluded that a strategically Coordinated Registry Network (CRN) is needed to collect and generate accessible data on temporomandibular disorder (TMD) and its care. The aim of this study was therefore to advance the clinical understanding, usage, and adoption of a core minimum dataset for TMD patients as the first foundational step toward building the CRN. Methods: Candidate data elements were extracted from existing data sources and included in a Delphi survey administered to 92 participants. Data elements receiving less than 75% consensus were dropped. A purposive multi-stakeholder sub-group triangulated the items across patient and clinician-based experience to remove redundancies or duplicate items and reduce the response burden for both patients and clinicians. To reliably collect the identified data elements, the identified core minimum data elements were defined in the context of technical implementation within High-performance Integrated Virtual Environment (HIVE) web-application framework. HIVE was integrated with CHIOS™, an innovative permissioned blockchain platform, to strengthen the provenance of data captured in the registry and drive metadata to record all registry transaction and create a robust consent network. Results: A total of 59 multi-stakeholder participants responded to the Delphi survey. The completion of the Delphi surveys followed by the application of the required group consensus threshold resulted in the selection of 397 data elements (254 for patient-generated data elements and 143 for clinician generated data elements). The infrastructure development and integration of HIVE and CHIOS™ was completed showing the maintenance of all data transaction information in blockchain, flexible recording of patient consent, data cataloging, and consent validation through smart contracts. Conclusion: The identified data elements and development of the technological platform establishes a data infrastructure that facilitates the standardization and harmonization of data as well as perform high performance analytics needed to fully leverage the captured patient-generated data, clinical evidence, and other healthcare ecosystem data within the TMJ/TMD-CRN.

Focus Groups to Inform the Development of a Patient-Reported Outcome Measure (PROM) for Temporomandibular Joint Disorders (TMDs).

BACKGROUND: Understanding symptoms of temporomandibular joint disorders (TMDs) can help doctors and patients document, monitor, and manage the disease and help researchers evaluate interventions. Patients with TMDs experience symptoms ranging from mild to severe, primarily in the head and neck region. This study describes findings from formative patient focus groups to capture, categorize, and prioritize symptoms of TMDs towards the development of a patient-reported outcome measure (PROM). METHODS: We conducted ten focus groups with 40 men and women with mild, moderate, and severe TMD. Focus groups elicited descriptions of symptoms and asked participants to review a list of existing patient-reported outcomes (PROs) from the literature and patient advisor input and speak to how those PROs reflect their own experience, including rating their importance. RESULTS: We identified 52 distinct concepts across six domains: somatic, physical, social, sexual, affective, and sleep. Focus groups identified the ability to chew and eat; clicking, popping, and other jaw noises; jaw pain and headaches; jaw misalignment or dislocation; grinding, clenching, or chewing, including at night; and ear sensations as most important. Participants with severe TMDs more often reported affective concepts like depression and shame than did participants with mild or moderate TMDs. CONCLUSION: Findings support PROM item development for TMDs, including selecting existing PROMs or developing new ones that reflect patients' lived experiences, priorities, and preferred terminology. Such measures are needed to increase understanding of TMDs, promote accurate diagnosis and effective treatment, and help advance research on TMDs.

Patients with temporomandibular joint disorders, or TMDs, have pain and other problems in their jaw, and face and neck areas. We talked to 40 patients with mild, moderate, and severe TMDs to learn about their symptoms. We also asked patients to review a list of TMD symptoms. They then chose the most important ones based on their experience. The data showed 52 TMD symptoms and functions across six domains. The patients chose the ability to chew and eat; clicking, popping, and other jaw noises; and jaw pain and headaches as most important. They also chose jaw misalignment or dislocation; grinding, clenching, or chewing, including at night; and ear feelings as important. Findings support creating patient-reported outcome measures, or PROMs, for TMDs. These PROMs should reflect patients' experiences and what is most important to them. Such measures can help doctors treat TMDs and help advance research on TMDs.

Transatlantic peer-to-peer learning: an initial feasibility analysis.

INTRODUCTION: Peer-to-peer learning is a well-established learning modality, which has been shown to improve learning outcomes, with positive implications for clinical practice. The purpose of this pilot study was to explore the feasibility of linking students from North America and Europe with a peer-to-peer learning approach. METHODS: Face and content validity studies were completed on the previously designed and validated online repository http://www.pilgrimshospital.com. Four medical students from the University of Toronto, Canada, were paired with four students from University College Cork, Ireland. Each student was invited to upload two pieces of information learned from a senior colleague that day. Each student was asked to review the information uploaded by their partner, editing with references if needed. Quantitative and qualitative evaluations of the e-peer system were conducted. RESULTS: Over the study period, the system recorded a total of 10 079 individual page views. Questionnaires completed by participants demonstrated that 6/8 found the system either "very easy" or "easy" to use, whereas all found that the system promoted evidenced-based and self-directed learning. Structured interviews revealed 3 main themes: The Peer Connection, Trust in Data Veracity, and Aid to Clinical Learning. CONCLUSION: This pilot study demonstrates it is feasible to link students from separate continents in a community of peer-to-peer learning. This is viewed positively by students and enhances evidenced-based learning, and the aspect of peer connectivity was important to participating students. Such an approach encourages peer cooperation and has the potential to disseminate key clinical learning experiences widely.

Practical aspects of analyzing vegetable oils in fire debris.

Vegetable oils undergo burning, self-heating, and spontaneous ignition, resulting in their presence in fire debris. As these processes can affect the fatty acid content of vegetable oils, it is important that debris be properly handled in order to obtain reliable and informative data. This research investigated changes in vegetable oil content as a result of storage conditions and different types of burning. Material spiked with vegetable oils and burned was stored under various long-term conditions, and debris was tested by heating overnight using passive headspace concentration. Results indicated that refrigeration is ideal for fire debris samples suspected of containing vegetable oils and that including passive headspace concentration in the analytical scheme would not affect oils. Spontaneous ignition experiments were conducted to compare the effects of various burning processes on vegetable oil content. Vegetable oils that experienced nonpiloted ignition, self-heating, and spontaneous ignition produced noticeably different chromatograms from those that underwent piloted ignition.

Extraction, derivatization, and analysis of vegetable oils from fire debris.

Vegetable oils have the ability to spontaneously heat under certain conditions, which may lead to spontaneous ignition. While the oils are not often encountered in forensic casework, they may be suspected in some fire cases. As these oils are not effectively analyzed using traditional fire debris analysis methods, a protocol must be established for extracting vegetable oils from fire debris. In this study, a protocol was developed for the extraction, derivatization, and analysis of vegetable oils from fire debris. Three derivatization methods were compared to establish an optimal derivatization procedure to convert the fatty acids found in vegetable oils to the fatty acid methyl esters (FAMEs) used in analysis. Three different gas chromatograph columns and programs were examined to determine which was best suited for the separation and analysis of FAMEs. The procedure was tested and refined using a variety of neat and burned vegetable oils, in addition to extractions from oils burned on commonly encountered fire debris materials. The findings of this research will serve as a starting point for further understanding and research of vegetable oils in fire debris.

"SURGENT" -- student e-learning for reality: the application of interactive visual images to problem-based learning in undergraduate surgery.

Information technology has the potential to transform surgical education. Combining symbolic, iconic, and enactive teaching modalities to construct an authentic conceptual model potentially can transform a primarily didactic learning experience into an interactive Web-enhanced one. This study sought to assess the introduction of a Web-based module to complement traditional surgical undergraduate curricula. Adopting the clinical case as its fundamental educational approach, an online resource simulating surgical clinical decision making ("SURGENT," http://www.surgent.ie) was developed, which consists of the interpretation of clinical photographs, laboratory data, and X-rays as well as the formulation of a management plan. Evaluation was in both a qualitative and a quantitative fashion. An anonymous postcourse survey (73% response) of 117 final medical students was used to by researchers to evaluate access, process, and outcome criteria. SURGENT was used by 98% of students, with 69% spending more than 30 minutes per session on the program. First-class honors in the final surgical clinical examination improved from 11% to 20% (p = 0.01) as compared with the previous control year. A Web-enhanced interactive surgical module in an undergraduate course can convey successfully information and understanding beyond the textbook. It is intended that SURGENT will supplement textbooks and ward experience, allowing students to develop their clinical decision-making skills.

Comparison of motor oils using high-temperature gas chromatography-mass spectrometry.

The analysis of motor oils has wide applications in the forensic science field from comparing lubricants transferred between an automobile and a victim or crime scene to differentiating the compositions of plastic explosives. In this study, 40 unused motor oils were analyzed and compared by high-temperature gas chromatography-mass spectrometry to determine the potential for oil individualization. Oil samples were also collected from the crankcase dipsticks of 30 cars. Twenty-six of these oils could be differentiated from each other based on visual comparisons of the unresolved envelope (baseline rise due to incomplete separation) and the resolved hydrocarbons in the raw total ion chromatograms (TICs) and smoothed TIC data. Four of these oils were analyzed as unknowns and were correctly related to the corresponding vehicle. The use of extracted ion profiles (EIPs) was explored as a means to further discriminate between the indistinct samples based on the polycyclic aromatic hydrocarbon (PAH) content. The research discussed in this paper demonstrated that differentiation of motor oils was possible by examining the TIC, smoothed TIC, and EIP data.

A quantitative comparison of smokeless measurements.

Measurements of the type and concentration of propellant and stabilizer additives in smokeless gunpowder are used by forensic scientists investigating the source of explosives and by military laboratories assuring the safety and efficacy of munitions. The National Institute of Standards and Technology recently assessed the state-of-the-practice of smokeless powder measurements through an international measurement comparison exercise. We here present results provided by the five participants (of 20 total) reporting quantitative as well as qualitative values for two handgun reloading powders. All five of these participants reported values for nitroglycerin (NG), ethyl centralite (EC), diphenylamine (DPA), and N-nitrosodiphenylamine (NnDPA). Several participants additionally reported the concentrations of secondary stabilizer decomposition products. The unstable NG propellant additive appears to be more susceptible to method-specific calibration biases then are the stabilizer additives. All results from one participant were strongly biased relative to those of the other four. The within-participant measurement uncertainties for all analytes were self-reported to be 1 to 5% relative; among the four concordant participants, the measurement ranges are 5 to 10% relative. There was little consistency among the participants as to what components of measurement variance were included in their uncertainty statements. A discussion of the certainties in these measurements and factors that affect the accuracy of gunpowder additive determinations is presented.

A qualitative comparison of smokeless powder measurements.

In the spring of 2000, the National Institute of Standards and Technology and nineteen participants conducted a comparison of smokeless powder additive compositional measurements. The purpose of this exercise was to determine the state-of-the-practice for forensic smokeless powder determinations. For the comparison, two handgun reloading powder samples were mixed and were compositionally evaluated for homogeneity by NIST. Participant laboratories included military, academic, and state/local, federal, and international forensic agencies. We solicited qualitative data identifying nitroglycerin, diphenylamine, N-nitrosodiphenylamine, and ethyl centralite. In addition, some laboratories provided identification of additional ingredients, such as nitrocellulose, or reported other measurements, such as dimensional morphology. In this paper, laboratory identification of the smokeless powder additives and a summary of the measurement methods used for the evaluations are presented. All laboratories correctly identified NG and the major stabilizers. Some disparity between laboratories was noted for the identification of minor (<0.01% by weight) stabilizers and stabilizer decomposition products.

Associating gunpowder and residues from commercial ammunition using compositional analysis.

Qualitatively identifying and quantitatively determining the additives in smokeless gunpowder to calculate a numerical propellant to stabilizer (P/S) ratio is a new approach to associate handgun-fired organic gunshot residues (OGSR) with unfired powder. In past work, the P/S values of handgun OGSR and cartridges loaded with known gunpowders were evaluated. In this study, gunpowder and residue samples were obtained from seven boxes of commercial 38 caliber ammunition with the goals of associating cartridges within a box and matching residues to unfired powders, based on the P/S value and the qualitative identity of the additives. Gunpowder samples from four of the seven boxes of ammunition could be easily differentiated. When visual comparisons of the cartridge powders were considered in addition to composition, powder samples from all seven boxes of ammunition could be reliably differentiated. Handgun OGSR was also collected and evaluated in bulk as well as for individual particles. In some cases, residues could be reliably differentiated based on P/S and additive identity. It was instructive to evaluate the composition of individual unfired gunpowder and OGSR particles. We determined that both the numerical centroid and dispersity of the P/S measurements provide information for associations and exclusions. Associating measurements from residue particles with those of residue samples collected from a test firing of the same weapon and ammunition appears to be a useful approach to account for any changes in composition that occur during the firing process.