ABSTRACT
BACKGROUND: High-resolution manometry has become the preferred choice of oesophagologists for oesophageal motor assessment, but the learning curve among trainees remains unclear. AIM: To determine the learning curve of high-resolution manometry interpretation. METHODS: A prospective interventional cohort study was performed on 18 gastroenterology trainees, naïve to high-resolution manometry (median age 32 ± 4.0 years, 44.4% female). An intake questionnaire and a 1-h standardised didactic session were performed at baseline. Multiple 1-h interpretation sessions were then conducted periodically over 15 months where 10 studies were discussed; 5 additional test studies were provided for interpretation, and results were compared to gold standard interpretation by the senior author. Hypothetical management decisions based on trainee interpretation were separately queried. Accuracy was compared across test interpretations and sessions to determine the learning curve, with a goal of 90% accuracy. RESULTS: Baseline accuracy was low for abnormal body motor patterns (53.3%), but higher for achalasia/outflow obstruction (65.9%). Recognition of achalasia reached 90% accuracy after six sessions (P = 0.01), while overall accurate management decisions reached this threshold by the 4th session (P < 0.001). Based on our data, the threshold of 90% accuracy for recognition of any abnormal from normal pattern was reached after 30 studies (3rd session) but fluctuated. Diagnosis of oesophageal body motor patterns remained suboptimal; accuracy of advisability of fundoplication improved, but did not reach 90%. CONCLUSIONS: High-resolution manometry has a steep learning curve among trainees. Achalasia recognition is achieved early, but diagnosis of other abnormal motor patterns and management decisions require further supervised training.
Subject(s)
Esophageal Achalasia/diagnosis , Esophagus/physiopathology , Gastroenterology/education , Adult , Esophageal Achalasia/physiopathology , Esophagus/surgery , Female , Fundoplication , Gastroenterology/methods , Humans , Learning Curve , Male , Manometry/methods , Surveys and QuestionnairesABSTRACT
Developmental Care Teams (DCT) have evolved in Neonatal Intensive Care Units (NICUs) in response to mounting evidence that developmental care is cost-effective and improves outcomes of critically ill newborns. Lack of national practice guidelines and standardized roles for DCT members prompted formulation and distribution of a questionnaire to obtain information regarding staff membership of DCTs, budgeting for DCTs, utilization of developmental care in practice, and education and developmental training of NICU staff. Questionnaires were sent to 50 NICUs in 30 states, with a return rate of 62% (31 of 50), representing 18 different states. Of those who responded, 64% had a DCT, and an additional 24% were in various phases of starting a team. Forty-three percent of the teams meeting on a regular basis did so monthly. Only 30% of those with a DCT had a dedicated budget to cover operating costs of their developmental program. Fifty-two percent of respondents had Neonatal Individualized Developmental Care and Assessment Program (NIDCAP)-certified staff at their institutions; however, nine other types of developmental specialists were also listed. Only four respondents indicated utilization of set criteria for initiation of a DCT consult, and 74% of those with DCTs initiated consults "when the need arises." NIDCAP assessments were used for parent teaching (54%), care plans (69%), care recommendations (46%), and at caregiver "discretion" (39%). The results of the survey validated an intense interest in developmental care. Approach to developmental care is variable between NICUs and implementation as outlined by NIDCAP is unusual. Practical guidelines for utilization and funding of DCTs are needed.
Subject(s)
Child Development , Intensive Care Units, Neonatal/organization & administration , Patient Care Team , Education, Continuing , Health Care Surveys , Health Education , Humans , Infant, Newborn , Surveys and Questionnaires , United States , WorkforceABSTRACT
PURPOSE: The purpose of this study was to compare temperature measurements from glass/mercury thermometers to Tempa.Dot Single-Use Clinical Thermometer, B-D Digital Fever Thermometer, Mon-a-Therm Model 1000 Skin Temperature Monitor, IVAC CORE.CHECK Tympanic Thermometer, and IncuTemp3 radiant warmer skin temperature sensor measurements. The effects of ten environmental, developmental, and pharmacological factors on thermometer readings were also assessed. DESIGN: The design was descriptive. SAMPLE: The convenience sample included 220 infants > or = 1,500 gm (average weight of 2,715 +/- 743 gm). Average age was 17 +/- 22 days of life. MAIN OUTCOME VARIABLE: The outcomes were comparisons between the "reference" axillary glass/mercury thermometer readings and axillary, skin, and tympanic measurements obtained from other thermometers. RESULTS: The B-D Digital Fever thermometer had the highest correlation with the glass/mercury thermometer for axillary temperature. Tempa.DOT measurements showed the next highest correlation with the glass/mercury thermometer measurements. Tympanic temperature measured by CORE.CHECK was moderately correlated with the glass/mercury thermometer measurement. Skin temperatures were influenced by nesting, clothing, swaddling, and probe site placement. Tympanic readings showed effects of bed type and environmental temperature.
