Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds

Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients—high-fidelity, manikin-based simulators (human patient simulator)—are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to “suspend disbelief,” and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.     

The co-marking of aged bodies and migrant bodies: migrant workers' contribution to geriatric medicine in the UK

This article sits at the nexus between two bodies of work, gerontology and migration research, both of which have theorised the body as the locus of stigma. Gerontologists, while acknowledging the significance of perceptions of the ageing body for engagement and participation in society, have often evaded direct engagement with physical and medical understandings of older bodies. In parallel, research which focuses on migration, race and the body has focused on how the migrant body is stigmatised both because of its somatic markers and because of the status of the frail older people whom they tend. Drawing on oral history interviews with UK born and South Asian overseas-trained geriatricians, the article argues that the two bodies, which are usually seen in negative ways, came together in meaningful ways in the development of the specialty of geriatric medicine. Thinking of the body as an assemblage with many elements, some of which are stigmatised but which can nevertheless be recuperated, helps us to think beyond stigma in the context of body work.     

Drug-induced anaphylactic reactions in Indian population: A systematic review

Background:Epidemiological data on drug-induced anaphylactic reactions are limited in India and are largely depending on studies from developed countries.Aim:The aim was to analyze the published studies of drug-induced anaphylaxis reported from India in relation with causative drugs and other clinical characteristics.Results:From 3839 retrieved references, 52 references describing 54 reactions were included. The mean age was 35.31 (95% CI: 30.52–40.10) years. Total female patients were 61.11%. Majority reactions were developed in perioperative conditions (53.70%), ward (20.37%) and home (11.11%). The major incriminated groups were antimicrobials (18.52%), nonsteroidal antiinflammatory drugs-(NSAIDs) (12.96%) and neuromuscular blockers (12.96%). Common causative drugs were diclofenac (11.11%), atracurium (7.41%) and β-lactams (5.96%). Cardiovascular (98.15%) and respiratory (81.48%) symptoms dominated the presentation. Skin tests and IgE assays were performed in 37.03% and 18.52% cases, respectively. The fatal cases were associated with complications (OR =5.04; 95% CI: 1.41–17.92), cerebral hypoxic damage (OR =6.80; 95% CI: 2.14–21.58) and preventable reactions (OR =14.33; 95% CI: 2.33–87.97).Conclusion:Antimicrobials, NSAIDs, and neuromuscular blockers are common causative groups. The most fatal cases can be prevented by avoiding allergen drugs.     

Popliteal entrapment syndrome

A case of a type of popliteal entrapment syndrome that does not include an anomalous course of the popliteal artery is presented. In situ thrombosis secondary to entrapment-induced stasis was the presumed cause of ischemic, symptomatology. Thorough knowledge of the possible causes of entrapment and biplane angiography (of the popliteal artery) with provocative maneuvers often are required for diagnosis. As in our patient, surgical release of the entrapment can lead to complete resolution of symptoms.     

Patients' views on the screening of a videotape on osteoarthritis in an orthopaedic outpatient department

This study explores both new and existing outpatients' views about the screening of an informational videotape on osteoarthritis in the waiting area prior to their appointment at an orthopaedic outpatient clinic in an outer London teaching hospital. The aim was to establish the usefulness of the videotape as perceived by patients, and to explore the extent to which the outpatient department environment affected patients' viewing of the tape. The findings revealed that over half the patients saw the entire tape, whilst over a quarter saw one part of it. The majority of patients rated the tape interesting, with over half reporting it as having practical value. However, noise in the outpatient environment was the main factor which affected patients' viewing of the tape.