Bringing anatomy to life: Evaluating a novel ultrasound curriculum in the anatomy laboratory.

As point-of-care ultrasound (POCUS) invades medical specialties, more students covet earlier ultrasound (US) training programs in medical school. Determining the optimal placement and format in the curriculum remains a challenge. This study uses student perceptions and confidence in interpreting and acquiring images to evaluate the effectiveness of an US curriculum and assesses their performance on US content. A unique US curriculum was incorporated into first-year clinical anatomy at Tufts University School of Medicine (TUSM). Students completed surveys evaluating changes in US confidence and perceptions. Mean ratings on pre- and post-surveys were compared using Mann-Whitney U tests. Performance on US examination questions was evaluated. Two independent evaluators coded narrative responses and NVivo software was used to identify common themes. Two hundred eleven students completed the US curriculum. Students reported higher post-curriculum mean confidence ratings on US comprehension, operation, image acquisition, artifact recognition, and normal image interpretation (P < 0.0001). US reinforced anatomy concepts and clinical correlates (9.56, ±0.97 SD; 9.60, ±1.05). Students disagreed with items stating learning US is too difficult (1.2, ±2.2) and that it interferes with learning anatomy (0.68, ±1.7). Students scored above passing on practical US knowledge questions, supporting survey data, and the relation to learning spatial relationships. Qualitative analysis identified seven major themes and additional subthemes. Limited integration of US breaks barriers in students' perceptions and confidence in performing POCUS. The TUSM US curriculum is a natural marriage of anatomy and POCUS applications, serving as a template for medical schools.

Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability.

Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint-in particular, the articular cartilage of the patella and trochlea morphology-can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.

Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique.

BACKGROUND: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. PURPOSE: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. RESULTS: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. CONCLUSION: The femoral physeal-sparing with transphyseal tibial drilling "hybrid" technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.

An exploratory study of cognitive style in performance on matched and mismatched tasks.

Researchers have suggested that task performance is often dependent upon the congruence of cognitive style and task. To explore this suggestion, 44 female and 4 male undergraduates were administered the Cognitive Style Analysis, the Closure Flexibility, the Composite Gestalt Completion Test, and the Vocabulary subtest from the WAIS. Specifically, four hypotheses were tested: (1) that participants with an analytic style will perform better than those with a wholistic style on the Closure Flexibility; (2) that participants with a wholistic style will perform better than those with an analytic style on the Composite Gestalt Completion Test; (3) that participants with an intermediate style will outperform persons with an analytic style on the Composite Gestalt Completion Test; and (4) that intermediate scorers would perform better than those with a wholistic style on Closure Flexibility. Only the second hypothesis was supported, so results provide only minimal support for the effect of match or mismatch of cognitive style and task performance.

Limitations of using dosimeters in impulse noise environments.

The National Institute for Occupational Safety and Health (NIOSH) investigated the capabilities of noise dosimeters to measure personal exposure to impulse noise. The two leading types of commercially available dosimeters were evaluated in terms of their ability to measure and integrate impulses generated from gunfire during live-fire exercises at a law enforcement indoor firing range. Sound measurements were conducted throughout the firing range using dosimeters, sound level meters, and a measurement configuration that consisted of a quarter-inch microphone and a digital audiotape recorder to capture the impulse waveforms. Personal dosimetry was conducted on eight shooters, an observer, and the range master. Peak levels from gunfire reached 163 decibels (dB), exceeding the nominal input limit of the dosimeters. The dosimeters "clipped" the impulses by acting as if the gunfire had a maximum level of 146 dB. In other cases, however, peak levels (e.g., 108 dB) were below the dosimeter input limits, but the dosimeters still showed a peak level of 146 dB. Although NIOSH recommends that sound levels from 80 to 140 dB (A-weighted) be integrated in the calculation of dose and the time-weighted average, our present data suggest this criterion may be inadequate. These results showed that some instruments are incapable of providing accurate measures of impulse sounds because of their electroacoustic limitations.

Noise exposure assessment and abatement strategies at an indoor firing range.

Exposure to hazardous impulse noise is common during the firing of weapons at indoor firing ranges. The aims of this study were to characterize the impulse noise environment at a law enforcement firing range; document the insufficiencies found at the range from a health and safety standpoint; and provide noise abatement recommendations to reduce the overall health hazard to the auditory system. Ten shooters conducted a typical live-fire exercise using three different weapons--the Beretta.40 caliber pistol, the Remington.308 caliber shotgun, and the M4.223 caliber assault rifle. Measurements were obtained at 12 different positions throughout the firing range and adjacent areas using dosimeters and sound level meters. Personal and area measurements were recorded to a digital audio tape (DAT) recorder for further spectral analysis. Peak pressure levels inside the firing range reached 163 decibels (dB) in peak pressure. Equivalent sound levels (Leq) ranged from 78 decibels, A-weighted (dBA), in office area adjacent to the range to 122 dBA inside the range. Noise reductions from wall structures ranged from 29-44 dB. Noise abatement strategies ranged from simple noise control measures (such as sealing construction joints and leaks) to elaborate design modifications to eliminate structural-borne sounds using acoustical treatments. Further studies are needed to better characterize the effects of firing weapons in enclosed spaces on hearing and health in general.