Assessment of hypothermia with a new “tympanic” thermometer

Objective. Rapid and accurate core temperature measurement is vitally important in trauma patients, especially in those with accidental hypothermia. We tested a new aural thermometer to measure “tympanic” temperatures and assessed its accuracy during normothermic and hypothermic cardiopulmonary bypass.Methods. Tympanic, esophageal, and blood temperatures were compared in 10 patients undergoing open-heart surgery. In addition, the stability and reaction time of the tympanic thermometer was evaluated in 5 volunteers in a cold room, with and without facial fanning.Results. We observed a good linear correlation between tympanic and esophageal (r = 0.96) and blood (r = 0.81) temperature measurements during normothermia and hypothermia. There was no evidence of iatrogenic ear lesions in any of the patients. In the cold-room tests, stability was excellent and the time for adjustment of tympanic temperature measurement was about 2 min (with and without facial fanning).Conclusion. The new tympanic thermoprobe is a simple, fast, and reliable device for measuring core temperature. The device was designed particularly for, and may be useful for, patients suffering from accidental hypothermia.     

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Purpose: The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed at exploring the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice. Methods: Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data. Results: In general, the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions: The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation. Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.

• Implications for Rehabilitation

• There is limited research exploring the use of visual software technologies featuring biomechanical data within stroke rehabilitation.

• The perspectives of stroke rehabilitation therapists about the potential of such tools are useful both in terms of planning trial evaluations, and implementation.

• Therapists were generally positive about the contribution of visual software tools in stroke rehabilitation, but highlighted a number of practical constraints which required addressing.

• Normalisation process theory provides a useful process evaluation methodology which can support both trial evaluation and implementation of such novel technologies within stroke rehabilitation.

     

Universities preparing health professionals for the 21st century: can something new come out of the traditional establishment?

To address clinical education in chronic disease management, the University of Alberta partnered with the local health authority to develop interprofessional team placements in diabetes chronic disease management. The objectives were to determine a meaningful and sustainable approach to interprofessional team placements. Pre-licensure students from medicine, nursing, nutrition and pharmacy participated in a project-based team experience designed to increase their discipline-specific knowledge of diabetes while enhancing their team process skills. Quantitative and qualitative research methods were used to evaluate project implementation and student outcomes. The majority of students reported learning "a great deal" about the roles of other health professionals and knowledge regarding the management of diabetes from the perspective of other health disciplines. However, several key learning outcomes were not fully accomplished; to enhance student's interprofessional team skills, increase their knowledge of interprofessional team functions and learn how to modify team function in a clinical setting. Creativity concerning relevant projects, varying settings, and differing models of service delivery should be encouraged, and flexibility within the project and process is essential for self-directed learning of student teams. New models of interprofessional clinical education, such as the chronic disease management model used in this study, have potential, if supported by the shift in health science programs culture.     

A new methodology for the estimation of fiber populations in the white matter of the brain with the Funk–Radon transform

The Funk–Radon Transform (FRT) is a powerful tool for the estimation of fiber populations with High Angular Resolution Diffusion Imaging (HARDI). It is used in Q-Ball imaging (QBI), and other HARDI techniques such as the recent Orientation Probability Density Transform (OPDT), to estimate fiber populations with very few restrictions on the diffusion model. The FRT consists in the integration of the attenuation signal, sampled by the MRI scanner on the unit sphere, along equators orthogonal to the directions of interest. It is easily proved that this calculation is equivalent to the integration of the diffusion propagator along such directions, although a characteristic blurring with a Bessel kernel is introduced. Under a different point of view, the FRT can be seen as an efficient way to compute the angular part of the integral of the attenuation signal in the plane orthogonal to each direction of the diffusion propagator. In this paper, Stoke's theorem is used to prove that the FRT can in fact be used to compute accurate estimates of the true integrals defining the functions of interest in HARDI, keeping the diffusion model as little restrictive as possible. Varying the assumptions on the attenuation signal, we derive new estimators of fiber orientations, generalizing both Q-Balls and the OPDT. Extensive experiments with both synthetic and real data have been intended to show that the new techniques improve existing ones in many situations.     

“Yes,and …” Exploring the Future of Learning Analytics in Medical Education

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Northeastern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. Commentators brainstormed “what's next” with learning analytics in medical education, including advancements in interaction metrics and the use of interactivity analysis to deepen understanding of perceptual, cognitive, and social learning and transfer processes.     

Relative and absolute reliability of the new “Step-Ex” step-execution test in elderly people with and without balance problems

Purpose: To evaluate the relative and absolute test–re-test reliability of a new step-execution test, “Step-Ex”, for clinical use in elderly with and without balance problems. Method: Test–re-test design to assess intrarater reliability. Thirty-four healthy community-dwelling elderly (65–87 years), 16 with balance problems, were tested twice two weeks apart. Step-Ex consists of two portable force platforms that register vertical ground reaction forces connected to a computer for easy detection of temporal events and phases (reaction-, preparation-, stepping- and step execution phase). Standing with one foot on each platform, the subjects were given a tactile stimulus on the heel to initiate rapid steps forward. Results: Test–re-test agreement was good to very good: ICC_2.6 0.83–0.87 (without balance problems) and 0.71–0.83 (with balance problems) with no apparent systematic differences between the tests. The SEM, i.e. the smallest detectable change that may indicate a real clinical improvement for a group of individuals was small, 4.6–8.6%. The smallest real difference, representing the smallest change that reveals clinical improvement for a single individual, was 13–24%. Conclusion: Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of balance training in elderly people with and without balance deficits.

Implications for Rehabilitation

• Balance deficits are common in the elderly population.

• To evaluate the effects of treatment or changes over time it is of great importance to have reliable instruments.

• Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of treatment or changes over time in elderly people with and without balance deficits.

     

A Rasch Analysis Validation of the Maslach Burnout Inventory–Student Survey with Preclinical Medical Students

Construct: Burnout is a psychological construct characterized by emotional exhaustion that arises from an excess of physical, emotional, and social demands over an extended period. Symptoms of burnout include withdrawal or disengagement from work. Burnout has become an important public health concern due to its association with severe negative consequences across numerous professions. Background: The most widely used instrument for measuring burnout is the Maslach Burnout Inventory (MBI). An adaptation of the MBI, the MBI–Student Survey (MBI-SS), was developed for college students. The MBI-SS consists of 15 items covering 3 domains of burnout: exhaustion, cynicism (CY), and professional efficacy (PE). Although studies have confirmed the validity of the MBI-SS for college student populations, studies of its use with medical students are limited. The purpose of this study was to employ the Rasch model to examine the psychometric properties of the MBI-SS when used with a population of preclinical medical students. Approach: Data were collected from 787 medical students who answered the MBI-SS at the conclusion of their 1st year. A maximum likelihood exploratory factor analysis for ordinal data confirmed the hypothesized three factor structure of the MBI-SS. Subsequently, a Rasch analysis was employed to further evaluate the measurement properties of MBI-SS. We used the Rasch Rating Scale model to investigate the extent to which the three MBI subscales conformed to proper measurement characteristics, including comprehensive coverage of person ability and item difficulty along the latent continuum. Results: Most of the 15 items on the MBI-SS effectively fit the Rasch Rating Scale Model, with minimal measurement error. Respondents effectively used the full range of the rating scale for all 15 items. Two subscales (PE and CY) contained items that were difficult for respondents to endorse, resulting in significant gaps along the measurement continuum. The CY subscale exhibited a slight floor effect. The 3 subscales showed good person reliability, good real-item reliability, and good person separation. Conclusions: The Rasch analysis confirmed that the MBI-SS works well for measuring burnout among preclinical medical students. However, the Rasch analysis was able to identify that additional items are needed to improve the performance of MBI-SS. New items would be targeted at reducing the floor effect for the CY subscale and filling the other gaps in measurement along the latent continuum for the PE and CY subscales.     

The Laurs of Hypnotic Communication and the “Lived in Imagination” Technique in Medical Practice

This article describes two common hypnotic communication techniques that can be used in anesthesiology and more generally for a variety of medical applications. First, the LAURS (listening, acceptance, utilization, reframing, suggestion) hypnotic communication structure is detailed. This technique allows clinicians to rapidly build patient rapport and maximize the chance of a suggestion being realized. Second, the “Lived in Imagination” technique can be used to supplement a less than perfect local anesthesia technique or help provide analgesia or sedation to support a patient undergoing minor or even major surgical procedures. These techniques may allow for an adjunctive, seamless integration during standard clinical care.     

Getting started with research “Writing-up the results of your research”

This paper gives an overview of the considerations and practical aspects of writing up the results of your research, which may be of interest to those beginning their research career or simply carrying out a research project for the first time as part of an academic qualification. It outlines practical steps for both writing up the results of your research as an academic report and thereafter disseminating your results more widely as a peer-reviewed scientific publication.     

Online Medical Control and Initial Refusal of Care: Does It Help to Talk with the Patient?

The use of online medical control (OLMC) for initial refusal of care is time‐consuming and has medical—legal risks. Objectives: This study attempted to answer the following: Does physician—patient communication (PPC) increase the rate of transport and at what cost in terms of increased physician time? Do altered mental status (AMS) patients agree to transport more frequently and do they require more physician time? Can senior emergency medicine resident (RES) and emergency medicine faculty (FAC) physicians be equally efficient in handling refusal calls? Methods: The study evaluated a retrospective cohort for six months at a single base station, university hospital. Online medical control audiotapes and written records of radio and telephone communications were reviewed. Results: One hundred forty‐seven refusal cases were analyzed, PPC was used 70 times, and 37 patients were transported. Twenty‐four of 70 (34%) patients with PPC agreed to be transported, while ten of 77 (13%) patients without PPC agreed to be transported (p = 0.002). Sixteen of 30 (53%) patients with AMS were transported compared with 21 of 117 (18%) patients with normal mental status (p = 0.00007). Call times were longer with PPC utilization [406.3 sec PPC vs 230.1 sec no PPC (p < 0.001)] and with AMS patients [411.2 sec AMS vs 289.1 sec no AMS (p = 0.028)]. The RES and FAC physicians did not differ in transport rates [21% RES vs 26% FAC (p = 0.612)] and call times [329.4 sec RES vs 310.4 sec FAC (p = 0.659)]. Conclusions: Although time‐consuming, the use of PPC is associated with more patients' agreeing to be transported. Patients with AMS are transported more frequently and they use more physician time. Emergency medicine RES and FAC physicians have equal efficiency and efficacy in handling these calls.