Assessment of Technical Competence in Distal Radius Fracture Fixation by a Volar Locking Plate: A Global Delphi Consensus Study.

PURPOSE: Volar locking plate fixation of distal radius fractures is a common orthopedic procedure and should be mastered by graduating orthopedic residents. Surgical education is transitioning from a traditional time-based approach to competency-based medical education. Valid and objective assessment is essential for successful transition. The purpose of this study was to develop a comprehensive, procedure-specific assessment tool to evaluate technical competence in volar locking plate osteosynthesis of a distal radius fracture. METHODS: International orthopedic/trauma experts involved in resident education participated as panelists in a four-round online Delphi process to reach consensus on the content of the assessment tool. Round 1 was an item-generating round, in which the panelists identified potential assessment parameters. In round 2, the panelists rated the importance of each suggested assessment parameter and reached consensus on which to include in the assessment tool. Round 3 yielded specific assessment score intervals for specific bone and fracture models and is not reported in this study. In round 4, the panelists assigned weights to the assessment parameters on a 1-10 scale to determine how each parameter should have an impact on the overall results. RESULTS: Eighty-seven surgeons, representing 42 countries, participated in the study. Round 1 resulted in 45 assessment parameters, grouped into five procedural steps. After round 2, the number of parameters was reduced to 39. After the final round, an additional parameter was removed and weights were assigned to the remaining parameters. CONCLUSIONS: Using a systematic methodology, a preliminary assessment tool to evaluate technical competence in distal radius fracture fixation was developed. A consensus of international experts supports the content validity of the assessment tool. CLINICAL RELEVANCE: This assessment tool represents the first step in the evidence-based assessment essential for competency-based medical education. Before implementation, further studies exploring validity of variations of the assessment tool in different educational contexts are required.

CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers.

CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

VISION: a regional performance improvement initiative for HIV health care providers.

INTRODUCTION: VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of clinicians who manage patients with HIV infection. METHODS: The 3-part activity consisted of (1) clinical practice assessment and development of an action plan for practice change, (2) completion of relevant education, and (3) reassessment. RESULTS: The activity did not change practitioners' performance in clinical status monitoring and in patient treatment, in large part because guidelines were being appropriately implemented at baseline as well as after the educational intervention. There was a trend toward improvement, however, in practitioner performance in the area of patient medication adherence (increased from 66% to 74%). DISCUSSION: Results observed in the VISION initiative were consistent with HIVQUAL metrics. Ongoing education in HIV is important, and VISION demonstrated performance improvement in medication adherence, a critical aspect of health care.

Solidification and stabilization of fly ash from mixed hazardous waste incinerator using ordinary Portland cement.

Fly ash samples from a mixed hazardous waste (MHW) incinerator were subjected to solidification and stabilization (S/S) studies using ordinary Portland cement (OPC) as the binder. Additives (i.e., activated carbon and rice husk) were also homogenized with the binder and waste to determine the effectiveness of the immobilization of heavy metals. The toxicity characteristics leaching procedure (TCLP), Japanese Leaching Test (JLT-13) and the American Nuclear Test 16.1 (modified) ANS 16.1 were used to gauge the leaching of heavy metals from the solidified matrixes. Compressibility strength of the solidified matrixes was also tested using the American Standard Testing Material (ASTM) test procedure for the compressive strength of hydraulic cement mortars.