Acceleration of the learning curve for mastering basic critical care echocardiography using computerized simulation

Purpose

To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE).

Methods

In this prospective bicenter study, noncardiologist residents novice in ultrasound followed either a previously validated training program with adjunctive computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE Healthcare) (interventional group; n?=?12) or solely the same training program (control group; n?=?12). All trainees from the same institution were assigned to the same study group to avoid confusion bias. Each trainee was evaluated after 1 (M1), 3 (M3) and 6 (M6) months of training using our previously validated scoring system. Competency was defined by a score?≥?90% of the maximal value.

Results

The 24 trainees performed 965 TTE in patients with cardiopulmonary compromise during their 6-month rotation. Skills assessments relied on 156 TTE performed in 106 patients (mean age 53?±?14 years; mean Simplified Acute Physiologic Score 2: 55?±?19; 79% ventilated). When compared to the control group, trainees of the interventional group obtained a significantly higher mean skills assessment score at M1 (41.5?±?4.9 vs. 32.3?±?3.7: P?=?0.0004) and M3 (45.8?±?2.8 vs. 42.3?±?3.7: P?=?0.0223), but not at M6 (49.7?±?1.2 vs. 50.0?±?2.7: P?=?0.6410), due to higher practical and technical skills scores. Trainees of the control group required significantly more supervised TTE to obtain competency than their counterparts (36?±?7 vs. 30?±?9: p?=?0.0145).

Conclusions

Adjunctive computerized simulation accelerates the learning curve of basic CCE in improving practical and technical skills and reduces the number of TTE examinations required to reach competency.

     

Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses

Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one-group pre-to-post-intervention design. Educational interventions included faculty-led, simulation-based case presentations using the Harvey cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer-based CD-ROM program. Outcome measures included a 31-item cognitive written exam, a 13-item skills checklist used in each of a three-station objective structured clinical exam, learner self-efficacy and satisfaction survey, instructor satisfaction and self-efficacy survey, and a participant logbook to record practice time using the self-learning materials. Thirty-six students who received the simulation-based training showed statistically significant pre-to-post-test improvement in cognitive knowledge and cardiovascular assessment skills.     

Gated thoracic magnetic resonance angiography at 3T: noncontrast versus blood pool contrast

Both noncontrast and contrast-enhanced approaches to gated thoracic magnetic resonance angiography (MRA) for aortic root evaluation have been reported at 3T. We compare qualitative and quantitative image quality measures for the two approaches, and assess the reproducibility of standard aortic measurements. Respiratory and cardiac gated MRA of the chest was performed at 3T in 45 patients: 23 after administration of iron-based blood pool contrast, and 22 without contrast. Image quality was assessed with a 5-point Likert scale, vessel lumen-to-muscle contrast ratios, and vessel wall sharpness. Two reviewers measured the ascending aorta diameter and valve annulus area. Interrater agreement was assessed using Bland–Altman plots and coefficient of variation (CV). Qualitative image quality was better with blood pool contrast in all principal vessels of the chest (mean Likert of 4.20?±?0.79 vs. 2.60?±?0.77, p?<?0.001). Quantitative assessment was also improved with higher contrast ratios in all vessels (5.26?±?3.3 vs. 1.90?±?0.53, p?<?0.001), and greater sharpness of the aortic annulus and ascending aorta (0.70?±?0.16 vs. 0.56?±?0.14 mm^?1, p?<?0.001, and 0.87?±?0.16 vs. 0.62?±?0.16 mm^?1, p?=?0.008, respectively). Reproducibility of measurement was marginally better for the ascending aorta diameter (CV of 2.80 vs. 3.23%), but substantially increased for the aortic valve annulus area with blood pool contrast (CV of 4.93 vs. 7.32%). The use of a blood pool contrast agent for gated thoracic MRA improves image quality compared to a noncontrast technique, and provides more reproducible measurements of the aortic valve annulus area.     

Goal satisfaction improves with individualized powered wheelchair skills training

Purpose: To determine improvements in goal satisfaction following individualized mobility-related powered wheelchair skills training and whether changes in satisfaction are maintained 3 months post-training.

Materials and methods: Seventeen powered wheelchair users, from two centres, who were randomized to the training intervention from a larger multicentre study, were included in this secondary analysis. The intervention consisted of five 30-min individualized Wheelchair Skills Training Program sessions. Participants rated their current satisfaction with each of their goals from 0 to 10 (10 being the highest) prior to training, immediately after the intervention, and approximately 3 months following the intervention. Themes relating to the participants’ goals were also explored.

Results: Goal satisfaction scores improved statistically (p?r?=?0.387, n?=?17, p?=?.125). The majority of goals set fell into the broader “manoeuvring” category.

Conclusion: Goal satisfaction following the Wheelchair Skills Training Program improved years after initially learning how to operate a powered wheelchair. The five training sessions were effective in improving goal satisfaction. The quantification of goal satisfaction appears to be a sensitive outcome for powered wheelchair users undergoing mobility-related training.

• Implications for rehabilitation

• Goal satisfaction improved following the Wheelchair Skills Training Program.

• Even with years of powered wheelchair experience, the majority of goals set fell into the broader “manoeuvring” category.

• An individual’s goal satisfaction may not correlate with whether they have attained their goal as determined by a trainer.

     

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

AimTo evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students’ generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants’ satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module.BackgroundFollowing the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated.DesignA mixed methods study incorporating quasi-experimental and qualitative components.MethodsWe recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants’ post-intervention satisfaction, experiences and opinions.ResultsPost-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings.ConclusionsThis study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students’ learning outcomes. Further studies should include a control group, evaluate students’ knowledge and skills, and retention of knowledge to confirm the true impact of such training.     

Evaluation of radiological risk during coronary angioplasty procedures: comparison of transradial and transfemoral approaches

Increasing operator experience and newer available interventional cardiology devices require reassessment of radiological risk related to percutaneous coronary interventions (PCI). We aimed at comparison of radiological risk and procedural data of PCIs performed by radial (RA) and femoral (FA) approach in real life patients. Detailed retrospective analysis of 1500 consecutive PCIs with the use of radial or femoral access was performed. Comparison between RA and FA groups included procedural time (PT), fluoroscopy time (FT), radiation dose and contrast volume usage. There was no significant differences between RA and FA procedures in FT (12.6?±?13.5 vs. 11.7?±?9.5 min), X-ray dose generated during PCI (805.9?±?615.9 vs. 792.2?±?633.9 mGy) and use of contrast medium (145.2?±?62.2 vs. 152.5?±?64.2 ml). Mean total PT was shorter in RA (43.7?±?24.5 min) than in FA group (47.2?±?30.13 min, p?<?0.02). Patients’ age positively correlated with FT (r?=?0.14, p?<?0.05) and PT (r?=?0.07, p?<?0.05) in RA but not in FA group (r?=?0.05; r?=??0.06, respectively). Despite younger age, PCIs in males needed higher usage of contrast medium (151.7?±?69.2 vs. 139.1?±?49.3 ml; p?<?0.001), and higher X-ray dose (887.0?±?660.4 vs. 657.8?±?515.2 mGy; p?<?0.001). Age significantly correlated with PT only in female (r?=?0.093, p?<?0.05) but not in male patients (r?=?0.015). We conclude that fluoroscopy times, X-ray dose and use of contrast medium were similar in RA and FA, but mean total procedural time was significantly shorter in RA than in FA group. However, older patients in RA group needed longer fluoroscopy and procedural times to complete PCI and this was not seen in FA.     

Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton

Aim: The main objectives of this study were to quantify clients’ satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton.

Methods: A group of 14 wheelchair users with a spinal cord injury, who finished a 6–8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from “0?=?totally disagree” to “100?=?completely agree”.

Results: Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7?±?0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3?±?6.9%), the attributes of the locomotor training program (84.5?±?6.9%) and their ability to learn to perform sit–stand transfers and walk with the robotic exoskeleton (79.6?±?17%). Respondents perceived some health benefits (67.9?±?16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7?±?8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3?±?0.1%).

Conclusion: This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials.

• Implications for Rehabilitation

• All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6–8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit–stand transfers and walk with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6–8-week locomotor training program with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise.

• Additional research on clients’ perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.

     

接触电离辐射护士接受防护培训及实施防护措施现状的调查

目的调查接触电离辐射护士接受防护培训及实施防护措施的现状。方法自行设计电离辐射损伤防护问卷,对50名护士进行调查。结果50名护士中仅2人接受过防护知识的培训,无1人能采取完善的防护措施,25人出现电离辐射伤症状。结论护理人员对电离辐射的自我防护较差,护理管理层对护士应加强职业损伤防护知识的培训教育。     

Robotically assisted percutaneous coronary intervention: benefits to the patient and the cardiologist

Robotic percutaneous interventional systems represent the future of interventional cardiology. Robotic technology significantly reduces operator exposure to ionizing radiation, and improves ergonomics in the cardiac catheterization laboratory, thereby preventing orthopedic injuries. It may enable more accurate stent implantation and reduce the incidence of contrast-induced nephropathy. Robotics has the potential of converting the current ‘high-risk’ catheterization laboratory into a safe, physician- and patient-friendly environment.     

Influence of videogames and musical instruments on performances at a simulator for robotic surgery

Objective: To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS).

Materials and methods: A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS.

Results: Subjects from group 3 achieved the best performances on overall score: 527.09?±?130.54 vs. 493.73?±?108.88 (group 2), 472.72?±?85.31 (group 1), and 403.13?±?99.83 (group 4). Statistically significant differences (p?p?=?.009) and for time of completion (p?=?.044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98?±?122.71 vs. 470.25?±?92.31), but without statistically significant difference (p?=?.646).

Conclusions: The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.     

Feasibility and safety of transradial approach for catheter ablation of idiopathic left ventricular tachycardia

Background

The feasibility and safety of the transradial approach for catheter ablation of idiopathic left ventricular tachycardia (ILVT) have not been evaluated. The aim of this study was to investigate the feasibility and safety of transradial approach for catheter ablation in ILVT patients.

Methods

Thirty consecutive ILVT patients with negative Allen??s test undergoing catheter ablation via transradial approach were enrolled to compare the safety and efficacy with 30 other ILVT patients who previously underwent catheter ablation via transfemoral approach.

Results

Ablation was successfully performed in all patients. In the transradial group, the total procedural and the fluoroscopy time (42.8?±?6.9?min and 9.7?±?1.9?min, respectively) were significantly shorter when compared with transfemoral group (52.8?±?8.4?min and 11.5?±?2.1?min, respectively) (both P?<?0.05). The two groups were similar in the number of current applications (4.1?±?0.8 vs. 4.4?±?1.1, P?>?0.05), the power energy (47.3?±?7.3 vs. 49.7?±?6.9?W, P?>?0.05), and the total duration of current application (110.3?±?15.6 vs. 112.3?±?16.5?s, P?>?0.05), respectively. The duration of hospitalization in transradial group was shorter than that in transfemoral group (4.1?±?0.9 vs. 5.8?±?1.1?days, P?<?0.05). During follow-up, there was no recurrence of tachycardia in all patients. One patient in transfemoral group developed access site complications while none occurred in the transradial group.

Conclusions

The transradial approach is feasible and safe for catheter ablation of ILVT.     

The impact of a simulation lab experiencefor nursing students

A simulation clinical learning experience was initiated by a diploma school of nursing at a multidisciplinary training and research facility for simulation-based education. The simulation focused on pediatric and obstetrical scenarios. The purpose of this study was to investigate the impact simulation laboratory experiences have on critical thinking, student satisfaction, self-confidence, and cognitive learning. With 63 students participating over four semesters, a positive response was found for satisfaction and self-confidence in learning; there was also a significant increase in cognitive knowledge. No definitive conclusion regarding critical thinking was established, but a discovery was made regarding the importance of process during the simulation.     

Improving education on C-arm operation and radiation protection with a computer-based training and simulation system

Purpose  To discuss an approach to improve education in C-arm operation and reduction of radiation hazards based on a computer based training and simulation system called virtX. Methods  virtX is equipped with a visualization of scattered radiation and means to include patient positioning changes in radiograph simulation. virtX was integrated in a course for ORP and evaluated based on questionnaires. Results  Response rate was 73 (n = 77), mean age 35.4 (±9.2) and professional experience 11.2± 10.4 years. 91% use a C-arm regularly, 8% casually and 1% not. 78% agree that the translation of patient dummy positioning changes to simulated X-ray images is sufficiently realistic, 1% disagree (neutral 17%). 79% state that they acquired new knowledge concerning avoiding unnecessary radiation exposure, 10% do not (neutral 11%). Conclusions  The virtX-approach of simulating radiograph generation including patient positioning and scattered radiation was evaluated positively concerning its suitability for imparting knowledge regarding radiation protection and C-arm operation.

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Noninvasive quantification of left-to-right shunt by phase contrast magnetic resonance imaging in secundum atrial septal defect: the effects of breath holding and comparison with invasive oximetry

To investigate the effect of breath-holding on left-to-right shunts in patients with a secundum atrial septal defect (ASD). Thirty-five consecutive patients with secundum ASDs underwent right heart catheterization and invasive oximetry. Phase-contrast magnetic resonance imaging (MRI) was performed for the main pulmonary artery and ascending aorta. All measurements were obtained during free breathing (FB) (quiet breathing; no breath-hold), expiratory breath-hold (EBH), and inspiratory breath-hold (IBH). Pulmonary circulation flow (Qp) and systemic circulation flow (Qs) were calculated by multiplying the heart rate by the stroke volume. Measurements during FB, EBH, and IBH were compared, and the differences compared to invasive oximetry were evaluated. There were significant differences among the measurements during FB, EBH, and IBH for Qp (FB, 7.70?±?2.68; EBH, 7.18?±?2.34; IBH, 6.88?±?2.51 l/min); however, no significant difference was found for Qs (FB, 3.44?±?0.74; EBH, 3.40?±?0.83; IBH, 3.40?±?0.86 l/min). There were significant differences among the measurements during FB, EBH, and IBH for Qp/Qs (FB, 2.38?±?1.12; EBH, 2.24?±?0.95; IBH, 2.14?±?0.97). Qp/Qs during FB and EBH correlated better with Qp/Qs measured by invasive oximetry than did IBH. The limit of agreement was smaller for EBH than for FB and IBH. In patients with secundum ASDs, Qp/Qs significantly decreased with breath-holding. The accuracy of the Qp/Qs measurement by MRI compared with invasive oximetry during EBH was higher than during FB and IBH.     

Regional contribution to ventricular stroke volume is affected on the left side,but not on the right in patients with pulmonary hypertension

To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (RV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMR). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (RHC) and CMR. CMR from 33 healthy adults (13 females) were used as controls. Left ventricular (LV) atrioventricular plane displacement (AVPD) and corresponding longitudinal contribution to LVSV was lower in patients (10.8?±?3.2 mm and 51?±?12?%) compared to controls (16.6?±?1.9 mm and 59?±?9?%, p?<?0.0001 and p?<?0.01, respectively). This decrease did not differ in patient with ejection fraction (EF) >50?% and <50?% (p?=?0.5) and was compensated for by increased LV lateral contribution to LVSV in patients (49?±?13?% vs. 37?±?7?%, p?=?0.001). Septal motion contributed less to LVSV in patients (5?±?8?%) compared to controls (8?±?4?%, p?=?0.05). RV AVPD was lower in patients (12.0?±?3.6 mm vs. 21.8?±?2.2 mm, p?<?0.0001) but longitudinal and lateral contribution to RVSV did not differ between patients (78?±?17?% and 29?±?16?%) and controls (79?±?9?% and 31?±?6?% p?=?0.7 for both) explained by increased RV cross sectional area in patients. LV function is affected in patients with PH despite preserved global LV function. The decreased longitudinal contribution and increased lateral contribution to LVSV was not seen in the RV, contrary to previous findings in patients with volume loaded RVs.     

Kinesiologic taping reduces morbidity after oral and maxillofacial surgery: a pooled analysis

Abstract

Background: Postoperative morbidity is a major disadvantage after oral and maxillofacial (OMF) surgery, often caused by pain, trismus and swelling affecting patients’ quality of life. The goal of this study was to examine the effect of kinesiologic taping (KT) on swelling, pain, trismus and patients’ satisfaction after OMF surgery. Materials and methods: Performing a pooled analysis of 96 patients that were assigned for maxillofacial treatment (midface fractures n?=?30, mandibular fractures n?=?26, wisdom tooth removal n?=?40) divided into treatment either with or without kinesiologic tape application. Tape was applied directly after surgery and maintained for at least 5?d postoperatively. Facial swelling was quantified at six specific points in time using a five-line measurement. Pain and degree of mouth opening was measured. Patients’ objective feeling and satisfaction was queried. Results: Application of KT after OMF surgery has a significant influence on the reduction of swelling decreasing the turgidity for 60% during the first 2?d after surgery. Evaluating all patients swelling was significantly lower in the KT treatment group (T2: 63.5?cm?±?4.3; T3: 62.5?cm?±?4.2; T4: 61.6?cm?±?4.2) than in the no-KT group (T2: 67.6?cm?±?5.0; T3: 67.0?cm?±?5.0; T4: 64.8?cm?±?4.8) at T2 (p?<?0.001), T3 (p?<?0.001), and T4 (p?=?0.001). VAS Pain values were scored significantly lower for the KT group (T1: 2.5?±?2.0 (p?=?0.006); T2: 1.7?±?2.0 (p?<?0.001); T3: 1.5?±?2.3 (p?=?0.004); T4: 0.6?±?1.1 (p?=?0.001) compared to the no-KT group (T1: 3.8?±?2.5; T2: 3.5?±?2.7; T3: 2.9?±?2.2; T4: 1.6?±?1.7). A statistically significant amelioration in mean mouth opening ability was observed in the KT group (T1-BL: ?0.08?cm?±?0.49 (p?=?0.025); T2-BL: 0.07?cm?±?0.59 (p?=?0.012); T3-BL: 0.20?±?0.63 (p?=?0.013); T4-BL: 0.42?±?0.59 (p?=?0.003)) compared to the no-KT group (T1-BL: ?0.47?cm?±?0.86; T2-BL: ?0.39?cm?±?0.84; T3-BL: ?0.24?±?0.89; T4-BL: ?0.13?±?1.02). Conclusion: KT after OMF surgery is a promising, simple, less traumatic, economical approach free from systemic adverse reaction upgrading patients’ quality of life.     

A deep learning approach with temporal consistency for automatic myocardial segmentation of quantitative myocardial contrast echocardiography

Quantitative myocardial contrast echocardiography (MCE) has been proved to be valuable in detecting myocardial ischemia. During quantitative MCE analysis, myocardial segmentation is a critical step in determining accurate region of interests (ROIs). However, traditional myocardial segmentation mainly relies on manual tracing of myocardial contours, which is time-consuming and laborious. To solve this problem, we propose a fully automatic myocardial segmentation framework that can segment myocardial regions in MCE accurately without human intervention. A total of 100 patients’ MCE sequences were divided into a training set and a test set according to a 7: 3 proportion for analysis. We proposed a bi-directional training schema, which incorporated temporal information of forward and backward direction among frames in MCE sequences to ensure temporal consistency by combining convolutional neural network with recurrent neural network. Experiment results demonstrated that compared with a traditional segmentation model (U-net) and the model considering only forward temporal information (U-net?+?forward), our framework achieved the highest segmentation precision in Dice coefficient (U-net vs U-net?+?forward vs our framework: 0.78?±?0.07 vs 0.79?±?0.07 vs 0.81?±?0.07, p?<?0.01), Intersection over Union (0.65?±?0.09 vs 0.66?±?0.09 vs 0.68?±?0.09, p?<?0.01), and lowest Hausdorff Distance (32.68?±?14.6 vs 28.69?±?13.18 vs 27.59?±?12.82 pixel point, p?<?0.01). In the visual grading study, the performance of our framework was the best among these three models (52.47?±?4.29 vs 54.53?±?5.10 vs 57.30?±?4.73, p?<?0.01). A case report on a randomly selected subject for perfusion analysis showed that the perfusion parameters generated by using myocardial segmentation of our proposed framework were similar to that of the expert annotation. The proposed framework could generate more precise myocardial segmentation when compared with traditional methods. The perfusion parameters generated by these myocardial segmentations have a good similarity to that of manual annotation, suggesting that it has the potential to be utilized in routine clinical practice.

     

Interprofessional,simulation-based training in end of life care communication: a pilot study

Abstract

This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z?=??5.887, p?=?0.000). The reported benefits need to be balanced against design and delivery issues that proved labour and resource intensive. Economic evaluation is worthy of further consideration.     

关节镜下两种双排缝合技术治疗肩袖大型撕裂的中期疗效比较*

目的比较关节镜下改良压配式双排缝合(improved-press-fit DR)技术及缝合桥(Suture-Bridge)技术治疗肩袖大型撕裂的中期疗效。方法回顾性分析2015年12月-2016年11月该院分别采用关节镜下Improved-press-fit DR技术(A组)及Suture-Bridge技术(B组)治疗大型肩袖全层撕裂的患者,每组各50例。A组中,男22例,女28例,年龄51～76岁,平均62.58岁;B组中,男27例,女23例,年龄46～75岁,平均60.72岁。两组患者均记录术中缝合固定时间,术后均肩外展6周固定,允许早期被动活动度训练,在治疗前后分别采用疼痛视觉模拟评分(VAS)、肩关节前屈和体侧外旋角度(ROM)、美国加州大学洛杉矶分校肩关节评分(UCLA)及美国肩肘外科协会评分(ASES)进行疗效评价,并比较末次随访时两组患者功能恢复情况,采用欧洲五维健康量表(EQ-5D)评估患者生活质量及满意度,并比较两组间差异。结果 A组较B组可明显缩短缝合时间,术后随访24～36个月,平均30.90个月。末次随访时,A组患者疼痛VAS评分(1.54±0.78)分,前屈上举(155.60±10.31)°,体侧外旋(32.70±8.02)°,UCLA评分(33.36±3.43)分,ASES评分(82.22±8.57)分,EQ-5D指数(0.73±0.02);B组患者末次随访时疼痛VAS评分(1.38±0.72)分,前屈上举(153.50±9.75)°,体侧外旋(34.70±6.02)°,UCLA评分(34.30±2.47)分,ASES评分(84.36±7.78)分,EQ-5D指数(0.72±0.01),两组患者术后所有评价指标较术前明显好转,差异均有统计学意义(P 0.05),两组间术后指标比较,差异无统计学意义(P 0.05)。两组患者均无肩袖再撕裂发生。结论两种技术治疗大型肩袖全层撕裂的临床效果均满意,Improved-press-fit DR技术可缩短手术时间,减少耗材使用,操作简便,是一种实用的缝合方法。     

Use of short roll C-arm computed tomography and fully automated 3D analysis tools to guide transcatheter aortic valve replacement

Determination of the coplanar view is a critical component of transcatheter aortic valve replacement (TAVR). The safety and accuracy of a novel reduced angular range C-arm computed tomography (CACT) approach coupled with a fully automated 3D analysis tool package to predict the coplanar view in TAVR was evaluated. Fifty-seven patients with severe symptomatic aortic stenosis deemed prohibitive-risk for surgery and who underwent TAVR were enrolled. Patients were randomized 2:1 to CACT vs. angiography (control) in estimating the coplanar view. These approaches to determine the coplanar view were compared quantitatively. Radiation doses needed to determine the coplanar view were recorded for both the CACT and control patients. Use of CACT offered good agreement with the actual angiographic view utilized during TAVR in 34 out of 41 cases in which a CACT scan was performed (83?%). For these 34 cases, the mean angular magnitude difference, taking into account both oblique and cranial/caudal angulation, was 1.3°?±?0.4°, while the maximum difference was 7.3°. There were no significant differences in the mean total radiation dose delivered to patients between the CACT and control groups as measured by either dose area product (207.8?±?15.2 Gy cm² vs. 186.1?±?25.3 Gy cm², P?=?0.47) or air kerma (1287.6?±?117.7 mGy vs. 1098.9?±?143.8 mGy, P?=?0.32). Use of reduced-angular range CACT coupled with fully automated 3D analysis tools is a safe, practical, and feasible method by which to determine the optimal angiographic deployment view for guiding TAVR procedures.