Twelve tips for integrating ultrasound guided peripheral intravenous access clinical skills teaching into undergraduate medical education.

Peripheral Intravenous access (PIV) is a procedure undertaken by Medical Practitioners and Non-Medical Practitioners. Traditional PIV uses a visual and tactile technique to locate blood vessels close to the surface of the skin. Chronic medical conditions, dehydration, obesity and recurrent intravenous access can make PIV challenging. Ultrasound (US) guided PIV is recommended to aid the identification of the arm arteries and veins and improve the success rate of needle placement in difficult cases. Medical and non-medical schools, and hospital organisations, are recognising the importance of US guided PIV education for undergraduate and postgraduate Medical and Non-Medical Practitioners. This to promote independence, efficiency and to improve patient safety. The aim of this 12 tips article is to highlight the considerations and practicalities of integrating and delivering, a practical based skills (PBS) session, on the use of US guided practice as an adjunct in difficult PIV, into the undergraduate medical education curricula.

The development of a pragmatic, clinically driven ultrasound curriculum in a UK medical school.

Whether ultrasound (US) should be incorporated into a medical undergraduate curriculum remains a matter of debate within the medical education arena. There are clear potential benefits to its early introduction particularly with respect to the study of living anatomy and physiology in addition to the learning of clinical skills and procedures required for the graduate clinical practice. However, this needs to be balanced against what is perceived as an added value in addition to financial and time constraints which may potentially lead to the sacrifice of other aspects of the curriculum. Several medical schools have already reported their experiences of teaching US either as a standalone course or as a fully integrated vertical curriculum. This article describes and discusses the initial experience of a UK medical school that has taken the steps to develop its own pragmatic vertical US curriculum based on clinical endpoints with the intent of using US to enhance the learning experience of students and equipping them with the skills required for the safe practice as a junior doctor.

Hydration and radiation effects on the residual stress state of cortical bone.

The change in the biaxial residual stress state of hydroxyapatite crystals and collagen fibrillar structure in sections of bovine cortical bone has been investigated as a function of dehydration and radiation dose using combined small- and wide-angle X-ray scattering. It is shown that dehydration of the bone has a pronounced effect on the residual stress state of the crystalline phase, while the impact of radiation damage alone is less dramatic. In the initial hydrated state, a biaxial compressive stress of approximately -150 MPa along the bone axis exists in the hydroxyapatite crystals. As water evaporates from the bone material, the stress state moves to a tensile state of approximately 100 MPa. The collagen fibrillar structure is initially in a tensile residual stress state when the bone is hydrated and the state increases in magnitude slightly with dehydration. Radiation dose in continually hydrated samples also reduces the initial biaxial compressive stress magnitude in the hydroxyapatite phase; however, the stress remains compressive. Radiation exposure alone does not appear to affect the stress state of the collagen fibrillar structure.