A simulated clinic to build interprofessional and authentic learning opportunities for shaping future practice in medical radiation professionals.

BACKGROUND: Simulation based learning provides an opportunity to increase student readiness prior to clinical placement. Cross disciplinary learning facilitates interprofessional competency building and improved student appreciation of other health professions, which adds another learning dimension to simulated scenarios. This paper outlines the approach to facilitating an interdisciplinary simulated clinic, where experiences were mapped to common professional capabilities. METHODS: After mapping skill sets and professional capabilities common to both Nuclear Medicine and Radiation Therapy, a mock clinic was planned to address common objectives. The aims of the activity were to prepare students for upcoming clinical placement and to build knowledge and skills in the interprofessional environment. All students were allocated roles of both the health care professional and the patient and introduced to the concept of interprofessional learning in a pre-brief session. During the simulated clinic phase students experienced the other modality through the patient perspective as well as practicing the clinician role within their own modality. Following the simulation students came together for a de-brief session. The activity was evaluated using both online polling and pre and post paper-based surveys. RESULTS: A total of 28 students participated in the simulation: 17 in radiation therapy and 11 in nuclear medicine. All participants agreed that the mock clinic was valuable preparation for clinical placement. Twenty-four completed pre and post surveys, revealed a collective improvement in several measures of interprofessional understanding and application. Free text polled responses in the de-brief session highlighted value for practicing communication, realistic physical resemblance to the real-life scenarios and time pressures. CONCLUSION: When two disciplines were combined in the simulated clinic, students learnt about each other's profession together. Evaluation showed positive improvements in both clinical readiness and interprofessional learning. Simulated tasks in healthcare education bought many benefits in preparing students for the workplace and in this example, enabled common objectives of interprofessional practice to be met.

Diagnostic test accuracy of imaging modalities for adults with acute pulmonary embolism: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the current literature on diagnostic test accuracy (DTA) of imaging modalities for adults with acute pulmonary embolism (APE). BACKGROUND: Medical imaging plays an integral role in evaluating and managing those with APE. Guidance for imaging modality use for APE diagnosis varies due to a lack of clinical standardisation. Despite this, CTPA remains the first-line imaging modality used by clinicians. METHODS: A literature search of PubMed, EMBASE, Trove and Mednar databases (2012-2020; English language) was performed. Studies assessing the DTA of imaging modalities for APE diagnosis were included. DTA studies methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2 tool). Results of eligible studies were pooled using random or fixed effects modelling the calculate the pooled DTA of explored imaging modalities for APE. The Higgins I2 test were performed to assess between study heterogeneity. RESULTS: 10 Studies, involving 998 participants, were enrolled and pooled using the random effects model. Of the explored modalities, magnetic resonance imaging (MRI), specifically pulmonary MRI and magnetic resonance pulmonary angiography (MRPA) exhibited the highest pooled DTA. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio for MRPA were 0.952 (95% CI, 0.881 to 0.987), 0.857 (95% CI, 0.637 to 0.97), 5.631 (95% CI, 2.163 to 14.659), 0.06 (95% CI, 0.007 to 0.537) and 80.310 (95% CI, 15.607 to 413.25) respectively. Based on the QUADAS-2 criteria, most studies presented low to moderate risk of bias and concern regarding applicability. CONCLUSION: The explored ultrasound and MRI protocols which exhibit a lower radiation burden when compared to the current gold standard computed tomography pulmonary angiography (CTPA), have acceptable diagnostic accuracy for APE and can be useful in certain situations.

Exploring the availability and impact of antenatal point-of-care ultrasound services in rural and remote communities: A scoping review.

BACKGROUND: There are global disparities in the provision of maternal health care, with women from rural communities and under-resourced countries expecting poorer access to healthcare services. This potentially compounds the existing higher burden of maternal and neonatal morbidity within these populations. In this setting, point-of-care ultrasound (PoCUS) has the potential to improve outcomes while mitigating challenges and barriers associated with the introduction of new medical technology. OBJECTIVES: To explore the availability and impact of PoCUS use for antenatal care (ANC) in under-resourced settings. METHODS: Medline, Embase and Scopus were searched with no year limit. Studies were included if the participants were pregnant women undergoing ANC in a rural setting or developing country and if the intervention was PoCUS use or training. RESULTS: A total of 3863 unique articles were identified, with 17 meeting the inclusion criteria. Studies originated from Africa, Asia, Central America and Australia. All studies reported that POCUS use for ANC produced positive outcomes. PoCUS introduction into routine ANC resulted in higher antenatal attendance and reduced maternal and neonatal mortality rates. It was demonstrated that it was feasible to provide local healthcare workers with limited training to perform quality scanning and reporting in their clinics. Methods and measures of these three primary outcomes varied between studies. CONCLUSION: Integration of PoCUS into ANC in the settings examined improved outcomes in under-resourced areas. Further research should investigate the availability of PoCUS services at a country level, the clinical impact and economic feasibility.

Molecular characterization and genetic diversity of ESBL-producing Escherichia coli colonizing the migratory Franklin's gulls (Leucophaeus pipixcan) in Antofagasta, North of Chile.

The role of wild animals, particularly migratory birds, in the dissemination of antibiotic-resistant bacteria between geographically distant ecosystems is usually underestimated. The aim of this work was to characterize the Escherichia coli population from Franklin's gull feces, focusing on the extended-spectrum ß-lactamase (ESBL)-producing strains. In the summer of 2011, 124 fecal swabs from seagulls (1 of each) migrating from the United States and Canada to the coast of Antofagasta, north of Chile, were collected. Samples were seeded on MacConkey agar supplemented with 2 µg/ml of cefotaxime and a single colony from each plate was tested for ESBL production by the double-disk ESBL synergy test. Antibiotic susceptibility was determined by the disk diffusion method and blaESBL genes were amplified and sequenced. The genetic diversity of isolates was explored by pulsed-field gel electrophoresis (PFGE)-XbaI and multilocus sequence typing. A total of 91 E. coli isolates with high rates of antibiotic resistance were identified. Carbapenemase production was not detected, whereas 67 of the 91 (54%) isolates exhibited an ESBL phenotype due to the presence of CTX-M-15 (61.3%), CTX-M-2 (19.3%), CTX-M-22 (16.1%), and CTX-M-3 (1.6%) coding genes. High genetic diversity was observed, with 30 PFGE patterns and 23 sequence types (STs), including ST131 (18%), ST44 (15%), ST617 (9%), and ST10 (9%). Results presented here are complementary to those previously reported by Hernández et al. in the same gull species, but located in the Central Region of Chile. Differences observed between gulls from both areas lead us to hypothesize that gulls from the northern location retain, as gut carriers, those resistant bacteria acquired in the United States and/or Canada.

Estudio retrospectivo de causas de trauma maxilofacial en Pasto, Colombia de 2001 a 2006 / A retrospective study of maxillofacial trauma causes in Pasto, Colombia from 2001 to 2006

Introducción: Las lesiones maxilofaciales son una condición frecuente en diferentes países, sin embargo, están asociadas a diversas causas. Metodología: Un estudio descriptivo fue realizado de Enero de 2001 a Diciembre de 2006 en tres hospitales y una institución de Pasto, Nariño, Colombia. 701 pacientes consecutivos del “Hospital San Pedro”, “Hospital Departamental de Nariño”, “Hospital Infantil Los Ángeles”, y el Instituto de Medicina Legal y Ciencias Forenses Seccional Nariño y Putumayo fueron evaluados. Variables como año, género, distribución anatómica de la fractura, se incluyeron. Análisis descriptivos fueron usados para determinar porcentajes e intervalos de confianza. Resultados: Las causas más comunes fueron violencia, con 350 (49,9%), accidentes en motos con 104 (14,8%), autos con 93 (13,3 %), y caídas con 66 (9,4%). Existió un incremento substancial de violencia en los años 2003 a 2004. Los niños de 0 a 6 años presentaron más caídas, mientras los de 15 a 24 años se asociaron con violencia, al igual que accidentes en motos y automóviles. La violencia fue relacionada con fracturas de huesos propios de la nariz, caídas con naso-orbito-etmoidal, y accidentes en motos y automóviles con politraumatismo y fracturas panfaciales. Conclusiones: Debido a que la violencia, accidentes en motos y automóviles son las principales causas de lesiones maxilofaciales en jóvenes, las políticas públicas deben ser dirigidas a ellos.

Introduction: Maxillofacial injuries are a frequent condition in different countries; however, they are associated to different causes. Methodology: A descriptive study was performed from January 2001 to December 2006 at three hospitals and one institution from Pasto, Nariño, Colombia. 701 consecutive patients at “Los Angeles Hospital”, “San Pedro Hospital”, “Departamental Universitario Hospital” and Departamental de Medicina Legal y Ciencias Forenses de Nariño – Putumayo Institute were evaluated. Variables such as year, gender, age, anatomical distribution of fractures were included. Descriptive analyses were used to determine percentages and confidence interval values. Results: The most common causes were violence, which accounted for 350 (49.9%). Motorcycle accidents in 104 (14.8%), car crashes in 93 (13.3 %), and falls in 66 (9.4%) cases. There was a substantial increase of violence as a cause in 2003 to 2004. 0 to 6 year-old children were related to falls, whilst 15 to 24 year-old youngsters were related to violence, as well as motorcycle and car accidents. Violence led to nasal fractures, falls to nasal-orbital-ethmoid injuries, and motorcycle and car accidents to politraumatism and panfacial fractures. Conclusions: Since violence, motorcycle, and car accidents were the major causes of maxillofacial injuries in youth, the public policies should be addressed to those.