scholarly journals S-Vest: a novel hybrid method to allow standardised patients to put on the objective physical examination findings of a disease

2019 ◽  
Vol 5 (2-3) ◽  
pp. 78-81
Author(s):  
Dale Berg ◽  
Katherine Berg
Keyword(s):  
Aortic Stenosis ◽  
Physical Examination ◽  
Clinical Skills ◽  
Low Cost ◽  
Simulated Patients ◽  
Teaching Tool ◽  
Educational Tools ◽  
Standardised Patients ◽  
Single Modality

BackgroundSimulation hybrids combine single modality simulation such as simulated patients (SP) with low-fidelity simulation to create a potentially more powerful set of educational tools. To make a hybrid that is credible, standardised and inexpensive remains a challenge. We describe the development of the simulation vest (S-Vest), an inexpensive, standardised teaching tool that is ‘worn’ by an SP to form a hybrid.MethodsWe have created a vest which contains a set of speakers placed in an anatomical manner and produce sounds. The sounds played from a multitrack audio player are recorded in vivo from a patient with the real disease findings. The SP provides history while the vest provides the objective palpable and auscultatory findings. The speakers are placed in the routine standardised locations taught in physical examination.ResultsWe have developed several case scenarios designed for the vest. One of these cases is an elderly patient with aortic stenosis. The aortic stenosis case audio file has four unique tracks recorded over the precordium. Each track is played at the speaker appropriate to the physical exam findings. The SP plays an elderly man with chest pain. The vest provides the sounds of a loud systolic murmur with marked diminishment of S2 and a palpable thrill.ConclusionsThe S-Vest is a low-fidelity, low-cost simulator to use in hybrid and simulation. The S-Vest can be used in a formative and summative Objective Structured Clinical Examination (OSCE) station and in skills attainment for learners in healthcare. We believe these tools will be of significant import to teaching clinical skills.

scholarly journals Virtual Integrated Patient: An AI supplementary tool for second-year medical students

2021 ◽  
Vol 6 (3) ◽  
pp. 87-90
Author(s):  
Juanita S. M. Kong ◽  
Boon See Teo ◽  
Yueh Jia Lee ◽  
Anu Bharath Pabba ◽  
Edmund J.D. Lee ◽  
...  
Keyword(s):  
Medical Students ◽  
Pilot Study ◽  
Physical Examination ◽  
Clinical Skills ◽  
History Taking ◽  
Clinical Rotations ◽  
Face To Face ◽  
Second Year ◽  
Standardised Patients ◽  
Real Patients

Introduction: With the COVID-19 pandemic, Singapore underwent a national lockdown in which most organisations, including schools were closed. Halting face-to-face tutorials resulting in decreased clinical contact for medical students. Prior to the pandemic, we had developed the Virtual Integrated Patient (VIP). Equipped with conversational technology, it provides students online practice in various clinical skills such as history-taking, physical examination and investigations. The aim of this paper is to describe the supplementary use of VIP in the second-year class, in which a pilot study was conducted. Methods: The VIP platform was introduced to the cohort and used to supplement the teaching of history-taking in the “Communication with Patients” (CWP) module for second-year students. Traditionally, CWP tutorials involve face-to-face history-taking from standardised patients (SPs). Students, who consented to participating in the trial, had an additional 3 weeks’ access to VIP to practice their history-taking skills. They completed a survey on their user experience and satisfaction at the end of the 3 weeks. Results: Out of the 106 participants, 87% strongly agreed or agreed that using VIP helped in remembering the content while 69% of them felt that VIP increased their confidence and competence in history-taking. Conclusion: VIP was well-received by students and showed promise as a tool to supplement history-taking tutorials, prior to students’ encounter with SPs and real patients. Hence, this trend showed its potential as an alternative when clinical rotations were delayed or cancelled. Further research can be done to evaluate its effectiveness in this context.

scholarly journals Objectively Structured Clinical Teaching (OSCT) in Undergraduate Clinical Teaching: A Pilot Study

2021 ◽  
Vol 13 (1) ◽  
pp. 17-30
Author(s):  
HMP Singh ◽  
Jaiprakash Mohanraj ◽  
Heethal Jaiprakash ◽  
Veena Joshi ◽  
Siva Achanna ◽  
...  
Keyword(s):  
Content Validity ◽  
Clinical Teaching ◽  
Cost Effective ◽  
Simulated Patients ◽  
Teaching Tool ◽  
Effective Manner ◽  
Significant Difference ◽  
Primary Care Medicine ◽  
Standardised Patients ◽  
Real Patients

In this study, the efficacy of a clinical teaching tool, objectively structured clinical teaching (OSCT) was assessed by comparing students’ performance in assessing standardised patients (SPs) and real patients (RPs). The final-year students were randomly divided into two arms and their performance in three different disciplines such as medicine, obstetrics and gynaecology (O&G) and primary care medicine (PCM) was assessed with RPs in one arm and SPs/simulated patients in the other. The assessments were conducted in history-taking, clinical examination and management stations by the content experts under a structured rubric. Students’ scores in each arm were compared in the respective disciplines and overall. The perceptions of both students and SPs were recorded. The OSCT and rotational average scores of the participant students in SPs and RPs were compared. The students’ mean scores for their rotational exam and OSCT were 65.31 ± 5.56 and 61.14 ± 8.53, respectively. The performance at the management station in O&G was significantly higher compared with medicine and PCM. The overall performance at all other stations in the three disciplines was comparable, with no significant difference. The reliability and content validity of OSCT was established by calculating Cronbach’s alpha and testing content validity. The results indicated that OSCT is an innovative and effective teaching tool that can be used in clinical teaching in the early clinical years to lower the student load in hospitals in a cost-effective manner.

scholarly journals DEVELOPING LOW-COST MANNEQUIN FOR UNDERGRADUATE IV LINE PHLEBOTOMY

2018 ◽  
Vol 7 (3) ◽  
pp. 191
Author(s):  
Doni Widyandana
Keyword(s):  
Undergraduate Students ◽  
Clinical Skills ◽  
Low Cost ◽  
Simulated Patients ◽  
Structured Interviews ◽  
Laboratory Education ◽  
Skills Lab ◽  
Skills Laboratory ◽  
Design Options ◽  
Laboratory Training

Background: Skills laboratory training had been providing students the opportunity to practice medical skills in a longitudinal education curriculum with various methods. The integration of skills lab learning methods and the use of mannequins could provide the students to practice invasive medical procedures on patients like the real condition in the clinical setting, but still remains a safe simulation. However, simulations in the skills lab require commercial mannequins that have been imported with limited design options and very expensive prices. The effect of this expensive training will hamper institutions to facilitate students’ learning. Therefore, Clinical Skills Laboratory, Faculty of Medicine, Universetas Gadjah Mada had initiated to produce low-cost and innovative mannequins. This study is aimed to develop low-cost mannequin in order to facilitate learning.Methods: This study is a comparison study to 3 types of simple infusions mannequin which will be attached to simulated patients. These 3 types of mannequin are based from the materials: silicone, silicone plus oil, and latex. There were three groups of respondents: 30 students, 15 teachers, and 15 simulated patients and were randomly invited to review those mannequins using a questionnaire and structured interviews. The data were analyzed using Mann-Whitney test and an “inductive content analysis”.Results: The low-cost mannequins were highly accepted by the respondents and the best mannequin was made from silicone (p<0.05). However, the mannequins need improvement on the skin design and the prevention of fluid leakage from the pumps and tubes. These mannequins were designed to stimulate undergraduate students not only to practice inserting needle to veins, but also learning how to communicate with patients at the same time.Conclusion: These low-cost mannequins can be used to practice integrated clinical skills in skills laboratory education. However, the mannequins should be evaluated and improved regularly. 

A technique for protecting delicate specimens during processing

1989 ◽  
Vol 47 ◽  
pp. 982-983
Author(s):  
R.J. Mount ◽  
R.V. Harrison
Keyword(s):  
Basilar Membrane ◽  
Low Cost ◽  
Organ Of Corti ◽  
Region Of Interest ◽  
Sensory Epithelium ◽  
Physical Damage ◽  
Air Drying ◽  
Specimen Handling ◽  
Two Component

The sensory end organ of the ear, the organ of Corti, rests on a thin basilar membrane which lies between the bone of the central modiolus and the bony wall of the cochlea. In vivo, the organ of Corti is protected by the bony wall which totally surrounds it. In order to examine the sensory epithelium by scanning electron microscopy it is necessary to dissect away the protective bone and expose the region of interest (Fig. 1). This leaves the fragile organ of Corti susceptible to physical damage during subsequent handling. In our laboratory cochlear specimens, after dissection, are routinely prepared by the O-T- O-T-O technique, critical point dried and then lightly sputter coated with gold. This processing involves considerable specimen handling including several hours on a rotator during which the organ of Corti is at risk of being physically damaged. The following procedure uses low cost, readily available materials to hold the specimen during processing ,preventing physical damage while allowing an unhindered exchange of fluids.Following fixation, the cochlea is dehydrated to 70% ethanol then dissected under ethanol to prevent air drying. The holder is prepared by punching a hole in the flexible snap cap of a Wheaton vial with a paper hole punch. A small amount of two component epoxy putty is well mixed then pushed through the hole in the cap. The putty on the inner cap is formed into a “cup” to hold the specimen (Fig. 2), the putty on the outside is smoothed into a “button” to give good attachment even when the cap is flexed during handling (Fig. 3). The cap is submerged in the 70% ethanol, the bone at the base of the cochlea is seated into the cup and the sides of the cup squeezed with forceps to grip it (Fig.4). Several types of epoxy putty have been tried, most are either soluble in ethanol to some degree or do not set in ethanol. The only putty we find successful is “DUROtm MASTERMENDtm Epoxy Extra Strength Ribbon” (Loctite Corp., Cleveland, Ohio), this is a blue and yellow ribbon which is kneaded to form a green putty, it is available at many hardware stores.

scholarly journals Effects of bisphosphonate and calcium carbonate on normal aortic valve and cholecalciferol induced in vivo rabbit aortic stenosis model

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Okutucu ◽  
C Sabanoglu ◽  
A Saglam Ayhan ◽  
E Tulumen ◽  
H Aksoy ◽  
...  
Keyword(s):  
Calcium Carbonate ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Calcium Supplementation ◽  
Group Iv ◽  
Histopathologic Examination ◽  
Group V ◽  
Group I ◽  
Alendronate Treatment

Abstract Background Calcific aortic valve disease (CAVD) is the most common valvular heart disease. Bisphosphonates are stable analogs of pyrophosphates and commonly prescribed in the treatment of osteoporosis. The effects of bisphosphonate treatment on CAVD are not clearly known and there are inconsistent results. Similarly, the effect of calcium supplementation on CAVD remains controversial. Purpose The aim of this study was to assess the effects of bisphosphonate therapy on the normal aortic valve and vitamin D induced in vivo rabbit aortic stenosis (AS) model. Methods The impact of calcium supplementation on the rabbit AS model was also evaluated. A total of 30 New Zealand white rabbits were divided into five equal groups: no treatment (Group I); 25,000 IU/day vitamin D3 (cholecalciferol) (Group II, rabbit AS model); 25,000 IU/day cholecalciferol plus 2500 mg/day calcium carbonate (Group III); 20 μg/kg/week intravenous alendronate (Group IV) and 25,000 IU/day cholecalciferol plus 2500 mg/day calcium carbonate plus 20μg/kg/week alendronate (Group V). Echocardiography was performed at baseline and after 12 weeks of treatment. The left ventricular mass index (LVMI), aortic valve area (AVA), transvalvular velocities and gradients were recorded. Radiologic and histopathologic examination was performed at the end of the 12th week. Control animals displayed no abnormalities of the aortic valve. Results There was no echocardiographic change in Group IV. In Groups II, III and V, there was a significant decrease in AVA and increases in transvalvular velocities and gradients. However, these stenotic changes were significantly prominent in Group V (p=0.001 for all, via repeated measures ANOVA). Moreover, LVMI was only increased in Group V (p&lt;0.05). Calcification of aortic valvar complex was detected in 14 (46.7%) cases by radiologic imaging and 10 (33.3%) cases by histopathologic examination. Most frequent calcification was found in Group V (5 for each method, 83.3%). Agatston, volume and equivalent mass scores of calcific foci in Group V were significantly higher than other groups (p&lt;0.05 for all). There was no significant difference between groups regarding with presence of osteoclasts in calcific foci. Conclusion Calcium supplementation has no effect on the in vivo rabbit AS model. Alendronate treatment aggravates the stenosis and increases the calcification in the rabbit AS model. Alendronate treatment has no effect on the normal valve in which there was no osteogenesis and osteoclastogenesis. Based on these findings, in patients with CAVD, alendronate treatment should be given with regular echocardiographic follow-up or may not be preferred. Central figure Funding Acknowledgement Type of funding source: None

scholarly journals Organ-specific, multimodal, wireless optoelectronics for high-throughput phenotyping of peripheral neural pathways

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Woo Seok Kim ◽  
Sungcheol Hong ◽  
Milenka Gamero ◽  
Vivekanand Jeevakumar ◽  
Clay M. Smithhart ◽  
...  
Keyword(s):  
High Throughput ◽  
Low Cost ◽  
Optoelectronic Device ◽  
Antenna System ◽  
Neural Pathways ◽  
Organ Specific ◽  
Coil Antenna ◽  
Sensory Fibers

AbstractThe vagus nerve supports diverse autonomic functions and behaviors important for health and survival. To understand how specific components of the vagus contribute to behaviors and long-term physiological effects, it is critical to modulate their activity with anatomical specificity in awake, freely behaving conditions using reliable methods. Here, we introduce an organ-specific scalable, multimodal, wireless optoelectronic device for precise and chronic optogenetic manipulations in vivo. When combined with an advanced, coil-antenna system and a multiplexing strategy for powering 8 individual homecages using a single RF transmitter, the proposed wireless telemetry enables low cost, high-throughput, and precise functional mapping of peripheral neural circuits, including long-term behavioral and physiological measurements. Deployment of these technologies reveals an unexpected role for stomach, non-stretch vagal sensory fibers in suppressing appetite and demonstrates the durability of the miniature wireless device inside harsh gastric conditions.

scholarly journals Optimizing the Reaction Conditions for the Formation of Fumarate via Trans-Hydrogenation

2021 ◽  
Author(s):  
Laura Wienands ◽  
Franziska Theiß ◽  
James Eills ◽  
Lorenz Rösler ◽  
Stephan Knecht ◽  
...  
Keyword(s):  
Aqueous Solution ◽  
Thermal Equilibrium ◽  
Reaction Rate ◽  
Low Cost ◽  
Hydrogen Gas ◽  
Metabolic Imaging ◽  
Reaction Conditions ◽  
Precursor Molecule ◽  
Solution Preparation

AbstractParahydrogen-induced polarization is a hyperpolarization method for enhancing nuclear magnetic resonance signals by chemical reactions/interactions involving the para spin isomer of hydrogen gas. This method has allowed for biomolecules to be hyperpolarized to such a level that they can be used for real time in vivo metabolic imaging. One particularly promising example is fumarate, which can be rapidly and efficiently hyperpolarized at low cost by hydrogenating an acetylene dicarboxylate precursor molecule using parahydrogen. The reaction is relatively slow compared to the timescale on which the hyperpolarization relaxes back to thermal equilibrium, and an undesirable 2nd hydrogenation step can convert the fumarate into succinate. To date, the hydrogenation chemistry has not been thoroughly investigated, so previous work has been inconsistent in the chosen reaction conditions in the search for ever-higher reaction rate and yield. In this work we investigate the solution preparation protocols and the reaction conditions on the rate and yield of fumarate formation. We report conditions to reproducibly yield over 100 mM fumarate on a short timescale, and discuss aspects of the protocol that hinder the formation of fumarate or lead to irreproducible results. We also provide experimental procedures and recommendations for performing reproducible kinetics experiments in which hydrogen gas is repeatedly bubbled into an aqueous solution, overcoming challenges related to the viscosity and surface tension of the water.

scholarly journals Genome-wide integration site detection using Cas9 enriched amplification-free long-range sequencing

2020 ◽  
Author(s):  
Joost van Haasteren ◽  
Altar M Munis ◽  
Deborah R Gill ◽  
Stephen C Hyde
Keyword(s):  
Long Range ◽  
Insertional Mutagenesis ◽  
Lentiviral Vector ◽  
Integration Site ◽  
Low Cost ◽  
Safety Evaluation ◽  
Read Length ◽  
Chromosomal Dna ◽  
Wide Range

Abstract The gene and cell therapy fields are advancing rapidly, with a potential to treat and cure a wide range of diseases, and lentivirus-based gene transfer agents are the vector of choice for many investigators. Early cases of insertional mutagenesis caused by gammaretroviral vectors highlighted that integration site (IS) analysis was a major safety and quality control checkpoint for lentiviral applications. The methods established to detect lentiviral integrations using next-generation sequencing (NGS) are limited by short read length, inadvertent PCR bias, low yield, or lengthy protocols. Here, we describe a new method to sequence IS using Amplification-free Integration Site sequencing (AFIS-Seq). AFIS-Seq is based on amplification-free, Cas9-mediated enrichment of high-molecular-weight chromosomal DNA suitable for long-range Nanopore MinION sequencing. This accessible and low-cost approach generates long reads enabling IS mapping with high certainty within a single day. We demonstrate proof-of-concept by mapping IS of lentiviral vectors in a variety of cell models and report up to 1600-fold enrichment of the signal. This method can be further extended to sequencing of Cas9-mediated integration of genes and to in vivo analysis of IS. AFIS-Seq uses long-read sequencing to facilitate safety evaluation of preclinical lentiviral vector gene therapies by providing IS analysis with improved confidence.

scholarly journals ALENDRONATE ACCELERATES CALCIFICATION AND BONE FORMATION IN CHOLECALCIFEROL INDUCED IN VIVO RABBIT AORTIC STENOSIS MODEL

2021 ◽  
Vol 77 (18) ◽  
pp. 1739
Author(s):  
Sercan Okutucu ◽  
Cengiz Sabanoglu ◽  
Arzu Saglam Ayhan ◽  
Erol Tulumen ◽  
Hakan Aksoy ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Bone Formation
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