scholarly journals Needs Assessment for Incoming PGY-1 Residents in Neurosurgical Residency

2015 ◽  
Vol 42 (1) ◽  
pp. 17-24 ◽  
Author(s):  
David M. Brandman ◽  
Faizal A. Haji ◽  
Marie C. Matte ◽  
David B. Clarke
Keyword(s):  
Intracranial Pressure ◽  
Lumbar Puncture ◽  
Clinical Skills ◽  
External Ventricular Drain ◽  
Patient Positioning ◽  
Program Directors ◽  
Likert Scale ◽  
Free Text ◽  
Raised Intracranial Pressure ◽  
Diverse Range

AbstractBackground: Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Methods: Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Results: Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. Discussion: We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program’s goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.

Surgical Treatment of Raised Intracranial Pressure

Neurotrauma ◽  
2019 ◽  
pp. 9-16
Author(s):  
Mohamed A. Zaazoue ◽  
Richard B. Rodgers
Keyword(s):  
Emergency Department ◽  
Intracranial Pressure ◽  
External Ventricular Drain ◽  
Altered Mental Status ◽  
Management Plan ◽  
Raised Intracranial Pressure ◽  
Icp Monitoring ◽  
Surgical Interventions ◽  
Head Ct ◽  
Medical Interventions

Traumatic brain injury (TBI) is a common problem encountered in the emergency department, and neurosurgeons are typically involved early in the management. Prompt physical examination and head CT are crucial to assess TBI patients and determine their management plan. Intracranial pressure (ICP) monitoring is indicated for patients with altered mental status and abnormal imaging. ICP management is a tiered approach, with early tiers involving nonsurgical, and medical interventions. For patients with uncontrolled elevation of ICP, there are three possible surgical interventions: external ventricular drain placement, evacuation of mass lesion, and/or decompressive craniectomy (unilateral or bilateral). Finally, when patients who underwent craniectomy recover from the acute phase of TBI, cranioplasty is performed for cosmetic purposes and potential neurological benefit.

Neonatal ventriculitis: a case series and review of literature

2020 ◽  
Vol 50 (3) ◽  
pp. 266-270
Author(s):  
Ramitha R Bhat ◽  
Prerna Batra ◽  
Ravi Sachan ◽  
Gurbachan Singh
Keyword(s):  
Intracranial Pressure ◽  
External Ventricular Drain ◽  
Fatal Outcome ◽  
Case Series ◽  
Age Group ◽  
Raised Intracranial Pressure ◽  
Review Of Literature ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotics

Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory.

scholarly journals How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?

2015 ◽  
Vol 19 (1) ◽  
Author(s):  
G. J. Du Toit ◽  
D. Hurter ◽  
M. Nel
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Lumbar Puncture ◽  
Predictive Value ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Ultrasound Measurement ◽  
Raised Intracranial Pressure ◽  
Cross Sectional ◽  
Nerve Sheath

Background: It has been well documented that ultrasound measurement of the optic nerve sheath diameter performed by an experienced operator shows good correlation with raised intracranial pressure, irrespective of the cause. Objective: To establish the accuracy of this technique performed by inexperienced operators.Method: A prospective analytical cross-sectional study was conducted. All patients ≥18 years of age who presented at our medical casualty and emergency departments with suspected meningitis were enrolled in the study. All patients were evaluated with the use of optic nerve sheath diameter ultrasound with or without computed tomography brain scan prior to lumbar puncture. Lumbar puncture opening pressure measurements were compared with the ultrasound measurements.Results: A total of 73 patients were enrolled in the study, of whom 14 had raised intracranial pressure. The study had a sensitivity of 50% (95% confidence interval (CI) 26.8%–73.2%) and specificity of 89.8% (95% CI 79.5%–95.3%) with a positive predictive value of 54.8% (95% CI 29.1%–76.8%) and negative predictive value of 88.3% (95% CI 77.8%–94.2%). The likelihood ratio of a positive test was 4.92 (95% CI 1.95–11.89) and that of a negative test 0.56 (95% CI 0.29–0.83). Cohen’s kappa value was 0.41 which indicates a moderate agreement. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 0.73 (95% CI 0.51–0.95). Conclusion: Ultrasound measurement of the optic nerve sheath diameter can be used to exclude raised intracranial pressure, even in the hands of inexperienced operators.

scholarly journals Management of Cerebellar Tonsillar Herniation following Lumbar Puncture in Idiopathic Intracranial Hypertension

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Kenneth R. Hoffman ◽  
Sean W. Chan ◽  
Andrew R. Hughes ◽  
Stephen J. Halcrow
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Decompressive Craniectomy ◽  
Idiopathic Intracranial Hypertension ◽  
Neuronal Injury ◽  
Raised Intracranial Pressure ◽  
Tonsillar Herniation ◽  
Cerebellar Tonsillar Herniation

Lumbar puncture is performed routinely for diagnostic and therapeutic purposes in idiopathic intracranial hypertension, despite lumbar puncture being classically contraindicated in the setting of raised intracranial pressure. We report the case of a 30-year-old female with known idiopathic intracranial hypertension who had cerebellar tonsillar herniation following therapeutic lumbar puncture. Management followed guidelines regarding treatment of traumatic intracranial hypertension, including rescue decompressive craniectomy. We hypothesize that the changes in brain compliance that are thought to occur in the setting of idiopathic intracranial hypertension are protective against further neuronal injury due to axonal stretch following decompressive craniectomy.

scholarly journals Thoughts from the darkroom…

2003 ◽  
Vol 2 (2) ◽  
pp. 66-68
Author(s):  
A Crean ◽  
Keyword(s):  
Intracranial Pressure ◽  
Lumbar Puncture ◽  
Evidence Based ◽  
Clinical Scenario ◽  
Raised Intracranial Pressure ◽  
Out Of Hours ◽  
Head Ct ◽  
Cranial Ct ◽  
Ct Brain ◽  
Rule Out

One of the commonest requests for out of hours imaging is for cranial CT in patients with possible meningitis. Telephone conversations like this may be familiar: “Hello I’m the medical SHO on call….I’d like to request a CT brain please…to rule out raised intracranial pressure before lumbar puncture…no we couldn’t get a good look at his fundi….they didn’t have any tropicamide in A and E…well, perhaps you’d like to do the LP if you don’t think a CT is necessary…” This type of request in fact may or may not be justified depending on the clinical scenario. The perception of radiologists is that few patients with possible meningitis require head CT before lumbar puncture; the perception of physicians is that the majority do. Pole-positions like this invariably generate conflict between our specialities. Can we use the available literature to guide us to a more evidence-based approach which both groups will find acceptable ?

Co-occurrence of acute ophthalmoplegia (without ataxia) and idiopathic intracranial hypertension

2018 ◽  
Vol 29 (4) ◽  
pp. NP1-NP4 ◽  
Author(s):  
Justin Yeak ◽  
Mimiwati Zahari ◽  
Sujaya Singh ◽  
Nor Fadhilah Mohamad
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Miller Fisher Syndrome ◽  
Upper Respiratory Tract ◽  
Raised Intracranial Pressure ◽  
Opening Pressure ◽  
Limb Weakness ◽  
Fisher Syndrome

Background: Acute ophthalmoparesis without ataxia was designated as ‘atypical Miller Fisher syndrome’ as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure. Case Description: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive. Conclusion: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

69. International medical graduates (IMGs) needs assessment study: A comparison between current IMG trainees and program directorss

2007 ◽  
Vol 30 (4) ◽  
pp. 66
Author(s):  
S. Verma ◽  
R. Zulla ◽  
M. O. Baerlocher
Keyword(s):  
Needs Assessment ◽  
Cultural Sensitivity ◽  
Clinical Skills ◽  
Program Directors ◽  
Likert Scale ◽  
International Medical ◽  
International Medical Graduates ◽  
Canadian Health Care System ◽  
Medical Graduates ◽  
Assessment Study

A needs assessment study was conducted to explore the types of issues or challenges IMG trainees encounter and the experiences of Program Directors with teaching this unique group. Both groups were asked to rate the importance of a series of issues in a horizontal curriculum using a 5-point Likert Scale. These issues fell under one of the following categories: Clinical Skills and Knowledge, Other Skills, Communication and Working Relationships, Macro Issues and Other Work-Related Issues. The scale was then collapsed to a 3-point Likert scale. Results were used to develop a horizontal curriculum for incoming IMGs to help ease their transition into residency training within the Canadian context. The majority of program directors (93%) and IMG trainees (63%) surveyed agreed that a horizontal curriculum for IMGs should be developed. Program Directors indicated that basic clinical skills and communication with team members were important to include (79% and 90%, respectively). IMGs felt that Marco Issues were importance in a horizontal curriculum, namely an orientation about the Canadian healthcare system and site hospitals (71% and 59%, respectively), followed by communication with patients (67%). Significant differences were found with regards to the inclusion of communication with other residents and the inclusion of orientation sessions on the Canadian Health Care System and site hospitals. These findings demonstrate there is a need for a core IMG curriculum. There is a slight disparity regarding what specific topics to include but a consensus between both groups exists on the primary domains of communication, inclusion of specialty specific skills and knowledge as well as professional interaction. Kraemer M. Educational Challenges of International Medical Graduates in Psychiatric Residents. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2006; 34(1):163-171. Whelan GP. Coming to American: The integration of the International Medical Graduates into the American Medical Culture. Academic Medicine 2005; 81(2):176-178. Majumdar, B, Keystone JS, Cuttress LA. Cultural Sensitivity Training among Foreign Medical Graduates. Medical Education 1999; 33:177-184.

scholarly journals Chiropractic students’ experiences on the use of virtual radiography simulation: a pilot observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Madeleine Shanahan ◽  
Tom Molyneux ◽  
Dein Vindigni
Keyword(s):  
Teaching And Learning ◽  
Online Survey ◽  
Clinical Skills ◽  
Patient Positioning ◽  
Free Text ◽  
Radiographic Images ◽  
Problem Solving Skills ◽  
Educational Value ◽  
Complementary Resource ◽  
Chiropractic Students

Abstract Background Virtual radiography provides students with an opportunity to practise their clinical skills in patient positioning and evaluating radiographic images. The purpose of this pilot study was to introduce Projection VR™, a software radiography simulation program, into a student chiropractic program and evaluate its potential application as a teaching and learning tool. Methods Undergraduate chiropractic students, enrolled in a radiographic course (unit within the chiropractic program), were invited to attend a scheduled laboratory where they were introduced to, and undertook purposefully designed activities using the radiography simulation. At the end of this activity, students were asked to complete an online survey (see Virtual Radiography Survey) to describe their experiences of the educational value of the software program. Descriptive statistics were used to evaluate outcomes. Content analysis was performed for free-text comments provided by respondents with key themes provided by the predetermined quantitative categories of the questionnaire. Results Responses were received from 44 out of the 47 students who attended the scheduled laboratory (response rate 92%). Overall students were positive about this simulation identifying that it was easy to use (95%) and that they could control the equipment as needed (95%). The main reported benefits included students being enabled to repeat tasks until they were satisfied with the results (98%) and being able to quickly assess images and determine if changes needed to be made (98%). Participants reported improvement in their understanding of the effect of exposure factors on patient radiation dose (93%) as well as their technical image evaluation (84%) and problem-solving skills (80%). Conclusions The results of this study suggest that virtual radiography is a valuable complementary resource in providing chiropractic students with radiographic knowledge and skills.

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