scholarly journals Evaluating bowel enterotomy closures in simulated deep body cavities using the reversing half-hitch alternating post and square knots: a randomized controlled trial

2021 ◽  
Vol 64 (1) ◽  
pp. E59-E65
Author(s):  
Edward A. Sykes ◽  
Madeline Lemke ◽  
Daniel Potter ◽  
Terry Li ◽  
Zuhaib M. Mir ◽  
...  
Keyword(s):  
Undergraduate Students ◽  
Controlled Trial ◽  
Body Cavity ◽  
Superior Performance ◽  
Training Methods ◽  
Knot Tying ◽  
Flat Surfaces ◽  
Novice Learners ◽  
Mean Time ◽  
Deep Body

Background: Square knots can be difficult to construct in deep body cavities. The reversing half-hitch alternating post (RHAP) surgical knot has noninferior tensile strength and performance characteristics in deep body cavities. We compared the enterotomy repairs of novice learners in simulated deep body cavities using RHAP versus square knots after proficiency-based training. Methods: Undergraduate students were randomized to RHAP (n = 10) or square knot (n = 10) groups and trained to defined proficiency. They then performed hand-sewn enterotomy repairs of cadaveric porcine small bowels on flat surfaces and in simulated deep body cavities. We recorded time to knot-tying proficiency and to enterotomy repair, and burst pressures for the repair. Results: Mean time-to-proficiency in knot tying was equivalent between the RHAP and square knot groups (23 [standard deviation (SD) 3] v. 21 [SD 2] min, p = 0.33). Mean time for enterotomy repair in deep cavities was shorter for the RHAP group (16 [SD 2] min v. 21 [SD 1] min, p = 0.02). Mean burst pressures for enterotomy repair were equivalent on flat surfaces (128 [SD 41] v. 101 [SD 36] mm Hg, p = 0.31), and were significantly higher for the RHAP group in simulated deep body cavities (32 [SD 13] v. 105 [SD 37] mm Hg, p = 0.05). Conclusion: The RHAP knots appear to have superior performance versus square knots when tied in a deep body cavity by novice learners. Future work should focus on demonstrating the clinical relevance and broad utility of the RHAP knot in abdominal surgery. Both knot types should be taught to novice learners.

Modifield Desarda Repair and Hernioplastia Lichtenstein Repair for Inguinal Hernia

2021 ◽  
Vol 2 (3) ◽  
pp. 01-05
Author(s):  
Pedro Rolando Lòpez Rodrìguez ◽  
Eduardo Garcia Castillo ◽  
Olga Caridad Leòn Gonzàlez ◽  
Jorge Agustin Satorre Rocha ◽  
Luis Marrero Quiala ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Controlled Trial ◽  
Operation Time ◽  
Lichtenstein Repair ◽  
Prospective Randomized Controlled Trial ◽  
The Mean ◽  
Group 2 ◽  
Location Type ◽  
Mean Time

Introduction: The objective of this study is to compare the outcomes of Modified Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 1342 patients having 1394 hernias operated from January 2008 to December 2020. 690 patients were operated using Lichtenstein repair and 652 using Desarda repair. The demographie data (Age,Sex) , hernia type and location , anesthetic , operative time , postoperative pain and complications were analysed. Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 52 minutes in Modified Desarda group and 42 minutes in the Lichtenstein group that is significant (p<0.05). The recurrence was 0.0 % in Modified Desarda group and 0.28 % in Lichtenstein group. But, there were 9 cases of infection to the polypropylene mesh in the Lichtenstein group, 2 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (7,6 %) as compared to Modified Desarda group (3.8 %). The mean time to return to work in the Modified Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. in Modified Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: The modified Desarda repair scores significantly on Lichtenstein repair in most of all aspects, including reexplorations and morbidity. Modified Desarda repair is a better option compared to Lichtenstein repair.

Online Synchronous Versus Asynchronous Software Training via Behavioral Modeling Approach

2011 ◽  
pp. 14-29
Author(s):  
Charlie C. Chen ◽  
R. S. Shaw
Keyword(s):  
Learning Environments ◽  
Undergraduate Students ◽  
Behavior Modeling ◽  
Training Methods ◽  
Face To Face ◽  
Sql Server 2000 ◽  
Long Run ◽  
Long Duration ◽  
Carry Over ◽  
Live Instruction

The continued and increasing use of online training raises the question of whether the most effective training methods applied in live instruction will carry over to different online environments in the long run. Behavior modeling (BM) approach—teaching through demonstration—has been proven as the most effective approach in a face-to-face (F2F) environment. A quasi-experiment was conducted with 96 undergraduate students who were taking a Microsoft SQL Server 2000 course in a university in Taiwan. The BM approach was employed in three learning environments: F2F, online synchronous and online asynchronous classes. The results were compared to see which produced the best performance, as measured by knowledge near-transfer and knowledge far-transfer effectiveness. Overall satisfaction with training was also measured. The results of the experiment indicate that during a long duration of training no significant difference in learning outcomes could be detected across the three learning environments.

The Effect of Expressive Writing on Symptoms of Depression in College Students: Randomized Controlled Trial

2019 ◽  
Vol 38 (5) ◽  
pp. 427-450
Author(s):  
Sarah M. C. Robertson ◽  
Stephen D. Short ◽  
Abigail Asper ◽  
Kelly Venezia ◽  
Catherine Yetman ◽  
...  
Keyword(s):  
Undergraduate Students ◽  
Expressive Writing ◽  
Controlled Trial ◽  
Physical Illness ◽  
Control Group ◽  
Depression Symptoms ◽  
First Year ◽  
Post Intervention ◽  
Physician Visits ◽  
Symptoms Of Depression

Introduction: The first year of college can be particularly difficult for students, as they typically face a number of emotional, developmental, social, and financial challenges. Expressive writing (EW) is a writing intervention that requires participants to write about their thoughts and feelings related to a particular event over several days. Methods: Participants in this study included 90 first-year undergraduate students. Participants were assigned to the EW condition (writing about their thoughts and feelings related to their transition to college) or a control condition (writing about any object or event of their choosing). Participants completed 3 consecutive days of writing, and then completed two follow-up visits that occurred one month and six months post-intervention. Participants were divided into two groups based on their initial depression scores (one group with minimal symptoms, and a second group with mild/moderate/severe symptoms). Results: Among participants in the mild/moderate/severe group, those in the EW condition demonstrated significant decreases in depression symptoms over the six-month study period, while participants in the control condition did not. Among this same subset of participants, those in the EW condition also demonstrated significantly fewer physician visits due to physical illness when compared to the control group. Changes in depression and physical illness visits were not found for participants with minimal symptoms of depression. Discussion: EW is a low-cost procedure that has been empirically demonstrated to alleviate symptoms of depression six months post-intervention. However, this finding only held for participants who were initially categorized in the group of participants with mild/moderate/severe symptoms of depression (as opposed to those participants initially categorized with minimal symptoms of depression). Clinical implications and future directions are discussed.

scholarly journals P15 Using prescribing nudges to reduce medication errors: paracetamol on paediatric intensive care

2020 ◽  
Vol 105 (9) ◽  
pp. e13.2-e14
Author(s):  
Jenny Gray ◽  
Nicole Aubrey ◽  
Emma Hipkin ◽  
Nicholas Jones
Keyword(s):  
Medication Errors ◽  
Undergraduate Students ◽  
Reduction Rate ◽  
Traditional Education ◽  
Electronic Prescribing ◽  
List Type ◽  
Training Methods ◽  
Dose Frequency ◽  
Prescribing Quality ◽  
Intravenous Paracetamol

AimParacetamol is widely available and its safety profile is relatively good. However, the risk associated with a paracetamol overdose is much greater in a neonate than that associated with an adult.In 2018, 8% of paediatric medication errors related to the use of paracetamol, including three 10x overdoses. These irregular but serious risks are difficult to manage over time due to degradation of heightened awareness. The aim of this project was to improve the prescribing quality of IV paracetamol on PICU and prevent recurrence of a 10-fold overdose by the implementation of multi-level changes.MethodElectronic prescribing (EP) has been in use on our unit since 2016. Small changes (prescribing nudges) in the configuration of the EP system can be used to improve prescribing quality. Forced functions, automation and standardisation have been found to be more effective in this than more traditional education and training methods.1 2The changes implemented in January 2019 were as follows:Forced function: All paracetamol prescriptions for patients under 1 year of age were capped at 180 mg (change from 1000 mg). The prescriber could not enter a number greater than 180 mg.Automation: All oral paracetamol prescriptions were changed to automatically prescribe 15 mg/kg 6 hourly regardless of age (previously 2 different options requiring the prescriber to input dose and frequency according to formulary directions).Standardisation/simplification: All oral paracetamol prescriptions were rationalised to a single option with automatic dose and frequency as above (previously 2 different options unnecessarily).Reminder/rule: A rule of ‘Consultant Approval’ was added to all intravenous paracetamol prescriptions. The intention of this was for a review of the prescription before use to ensure appropriate use and dose/frequency. This could not be forced, so an education package was launched across the unit by the quality improvement group.Prescription details were downloaded from the EP system for 3 month periods pre and post changes. he data was audited by pharmacy undergraduate students for prescribing accuracy.ResultsThe forced function, automation and standardisation options were implemented with 100% compliance. The ‘consultant approval’ rule was followed in 23% of cases. Consultant review led to a 58.6% reduction of IV paracetamol prescriptions on the unit and zero prescriptions for the first 2 months post implementation. The usage of oral paracetamol increased accordingly. This change corresponded to an overall reduction rate of 41.7% for intravenous paracetamol prescriptions.ConclusionsThis project demonstrates how changes that increase automation within prescribing can reduce error and that implementation is more successful than education. A limitation of our data analysis was that we did not measure the effect on pain relief or pain scores in the patients who did not receive IV paracetamol compared to those who did.ReferencesCafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. Healthcare Quarterly 2012; 15: 24–29.Patel Ms, et al. Nudge units to improve the delivery of healthcare NEJM 2018; 378: 214–216.

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