Evaluation of a web-based interactive heart failure patient simulation: a pilot study

Background

There is a gap between the evidence and the management of patients with heart failure. To improve knowledge uptake, we have developed a web-based heart failure simulation that was designed to be fun, realistic, and interactive. We sought to determine whether clinicians will use the web-based simulation of patients with heart failure and whether it will improve their knowledge compared to the latest heart failure guidelines.

Methods

Internists were asked to manage 3 simulated patients with heart failure. We measured knowledge before and after the simulation, analyzed users' performance managing the cases, and assessed their satisfaction with the website.

Results

With 10 internists, there was no change in knowledge seen with 69% in before and after test scores. There was a trend to improvement in the performance scores in how users managed the cases with 77.3% in the first case, 81.5% in the second case (P = 0.21 compared to the first score), and 85.0% in the third case (P = 0.02 compared to the first score). The participants' satisfaction with the website was high.

Conclusions

In this pilot study, no change in short-term knowledge was seen with this web-based heart failure patient simulation. There was an improvement in management of simulated cases and user satisfaction was high.     

Reconstruction with galeal frontalis flap of depressed forehead region in progressive hemifacial atrophy

Parry-Romberg syndrome is characterized by progressive hemifacial atrophy that is the lack of tissue (generally soft tissue and rarely bone and muscle) in the atrophic area of the face. The etiology and the incidence of this pathologic process are uncertain, but it is relatively rare and self-limited. The objective of this study is to present 21-year-old female patient with progressive hemifacial atrophy who was reconstructed with composite galeal frontalis flap. Although many reconstructive methods have been described, reconstruction of both eyebrow deficiency and forehead atrophy with composite galeal frontalis flap was not described before.     

Management of endometrial polyps diagnosed before or during ICSI cycles

This retrospective study aimed to shed light on the management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. The study included all fresh ICSI cycles performed in the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared with 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared with 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to clinical pregnancy (29.8% versus 38.3%) and live-birth (25.5% versus 31.9%) rates per transfer, as were patients diagnosed with an endometrial polyp during ovarian stimulation (clinical pregnancy rates 45.3% versus 46.9%; live-birth rates 40.6% versus 39.8%). In conclusion, further studies are required to identify the most appropriate management of endometrial polyps.     

Effect of air bubble localization after transfer on embryo transfer outcomes

Objectives

Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes.

Study design

Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal.

Results

The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups.

Conclusions

An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer.     

Effect of blood and mucus on the success rates of embryo transfers

Objectives

To provide information about the effects of blood and mucus on the embryo transfer (ET) catheters after transfer on embryo transfer outcomes.

Study design

Retrospective analysis of 8311 ultrasound-guided embryo transfers performed in a single center. In 6897 cases (82.9%), there were no blood on the catheter after ET, 1168 transfers were associated with mild blood (14.1%), 33 transfers with moderate blood (0.4%) and 213 transfers with severe blood (2.6%). A total of 6162 transfer catheters were free of mucus (74.8%), whereas mucus was detected on 2081 catheters (25.2%).

Results

The implantation rate (IR) was highest in the group with no blood on the transfer catheter, and lowest in the group with severe blood on the catheter. The clinical pregnancy rate (CPR) was lowest in the group with severe blood on the catheter. The presence of mucus on the catheter was found to have no effect on IR, CPR, biochemical pregnancy rates, miscarriage rates and live birth rates.

Conclusions

This study showed decreased IR, CPR and live birth rates in ETs associated with blood on the catheter. Mucus on the catheter appeared to be a simple contamination in this study and pregnancy rates remained unaffected.     

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.