Using e-learning for maintenance of ALS competence

ContextA well-suited e-learning program might be a feasible strategy to maintain competence following a resuscitation course.AimThis study had 2 aims: (1) to examine the effect of an e-learning program as a booster of competence acquired from an Advanced Life Support (ALS) course. (2) To identify factors related to the use of the e-learning program.Materials and methodsThe study contained two parts pertaining to the two aims. The first part was a prospective single blinded randomised controlled study on junior doctors. The intervention was the monthly use of an e-learning program during one year and effect was measured as ALS-competence, a composite of a knowledge and skills test.The second part was a telephone interview of the intervention group. An interview guide was constructed based on existing knowledge of e-learning. In order to identify factors explaining the use of e-learning a univariate correlation was used to select significant variables to be included in a multiple regression analysis.ResultsOf the 134 invited to participate, 103 accepted the invitation. There were 79/103 (77%) participants, 40/51 in the intervention group and 39/52 in the control group. There was no difference between the groups with regards to ALS competence. Only ‘social interaction’ was an individually significant factor influencing the use of the e-learning program.ConclusionsThis study did not demonstrate an effect of an e-learning program as a booster of competence acquired from an ALS course. The primary factor influencing the use of e-learning was the lack of social interaction.     

The European Trauma Course (ETC) and the team approach: Past,present and future

The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from other trauma courses, are a strong focus on team training and a novel modular design that is adaptable to the differing regional European requirements.This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development.     

Population-based study of acute respiratory infections in children,Greenland

Acute respiratory infections (ARI) are frequent in Inuit children, in terms of incidence and severity. A cohort of 294 children <2 years of age was formed in Sisimiut, a community on the west coast of Greenland, and followed from 1996 to 1998. Data on ARI were collected during weekly visits at home and child-care centers; visits to the community health center were also recorded. The cohort had respiratory symptoms on 41.6% and fever on 4.9% of surveyed days. The incidence of upper and lower respiratory tract infections was 1.6 episodes and 0.9 episodes per 100 days at risk, respectively. Up to 65% of the episodes of ARI caused activity restriction; 40% led to contact with the health center. Compared with studies from other parts of the world, the incidence of ARI appears to be high in Inuit children.     

Assessment of feasibility of workplace health promotion

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.     

Serum cholesterol esterifying and cholesteryl ester hydrolyzing activities in liver diseases: relationships to cholesterol, bilirubin, and bile salt concentrations

Patients with acute hepatitis and chronic alcoholic liver disease had decreased net serum cholesterol esterifying activity (CEA) which correlated positively with the percentages and concentrations of cholesteryl esters in their serum. These cholesterol parameters also correlated negatively with serum bilirubin concentrations, but bilirubin added to sera in vitro failed to influence CEA. The decreased net CEA in the patients was not due to its inhibition by serum bile salts. The sera from five patients catalyzed a net hydrolysis of cholesteryl esters rather than a net esterification of free cholesterol. Since serum cholesteryl ester hydrolase activity may also have been present in the patients with decreased CEA, net CEA cannot be equated with the activity of lecithin-cholesterol acyl transferase (LCAT) in patients with liver disease. The relative contributions of LCAT and cholesteryl ester hydrolase activities to CEA in disease states remain to be evaluated by mutually independent assays. Nevertheless, the correlations found between net CEA and the concentrations and percentages of cholesteryl esters support the concepts that serum cholesterol esterifying activity is physiologically important in the formation of serum cholesteryl esters and that decreased CEA is one mechanism for the decreased level of cholesteryl esters seen in patients with liver diseases.     

Optical biopsy of lymph node morphology using optical coherence tomography

Optical diagnostic imaging techniques are increasingly being used in the clinical environment, allowing for improved screening and diagnosis while minimizing the number of invasive procedures. Diffuse optical tomography, for example, is capable of whole-breast imaging and is being developed as an alternative to traditional X-ray mammography. While this may eventually be a very effective screening method, other optical techniques are better suited for imaging on the cellular and molecular scale. Optical Coherence Tomography (OCT), for instance, is capable of high-resolution cross-sectional imaging of tissue morphology. In a manner analogous to ultrasound imaging except using optics, pulses of near-infrared light are sent into the tissue while coherence-gated reflections are measured interferometrically to form a cross-sectional image of tissue. In this paper we apply OCT techniques for the high-resolution three-dimensional visualization of lymph node morphology. We present the first reported OCT images showing detailed morphological structure and corresponding histological features of lymph nodes from a carcinogen-induced rat mammary tumor model, as well as from a human lymph node containing late stage metastatic disease. The results illustrate the potential for OCT to visualize detailed lymph node structures on the scale of micrometastases and the potential for the detection of metastatic nodal disease intraoperatively.     

Does prolonged pneumoperitoneum affect oxidative stress compared with open surgical procedures?

BACKGROUND AND PURPOSE: As laparoscopic surgery has evolved, it has become part of the urologic surgical armamentarium and is now used to perform more complex procedures. Carbon dioxide, used to create pneumoperitoneum, produces physiologic changes in various organs, including the kidneys. Such changes are associated with altered redox status because of the release of free radicals and changes in oxidative stress signals. It is unknown whether prolonged pneumoperitoneum is associated with an increase in oxidative stress compared with open surgery. The objective of this study was to compare oxidative stress in patients undergoing urologic laparoscopic and open operations. PATIENTS AND METHODS: Urine samples were obtained immediately preoperatively, immediately postoperatively, and at 6 and 18 hours after surgery from 10 patients who underwent urologic laparoscopic surgery and 10 patients who underwent open surgery. Concentrations of the oxidative stress marker isoprostane (8- iso-prostaglandin F2a) were measured, and the results were analyzed with respect to clinical factors associated with the type of surgery. RESULTS: Urinary isoprostane concentrations (mean +/- SEM) in the laparoscopic and open groups showed an increase immediately after surgery to 189.0 +/- 64.2% and 141.1 +/- 45.8% of the preoperative values, respectively. A decrease in isoprostane was subsequently observed in both groups at 6 hours postoperatively, with preoperative values restored at 18 hours postoperatively (126.3 +/- 19.7% and 89.5 +/- 55.9% at 6 and 18 hours, respectively, in the laparoscopic group and 130.7 +/- 41.6% and 88.7 +/- 20.4% at 6 and 18 hours, respectively, in the open-surgery group). Although in both groups the peak PGF 2a concentration was observed immediately (0 hours) postoperatively, no significant differences were observed between the groups at 0, 6, and 18 hours. In the laparoscopic-surgery group, the mean increase tended to be higher and the decrease to be less prolonged than in the open-surgery group. CONCLUSION: Oxidative stress, as measured by urinary 8-iso-prostaglandin F2a, is produced by both laparoscopic and open urologic surgery. The findings of our nonrandomized study suggest a pattern of increased oxidative stress postoperatively with either type of surgery, with subsequent return almost to preoperative levels. Prolonged laparoscopic operative time did not affect oxidative stress levels.     

Technical modifications for robot-assisted laparoscopic pyeloplasty

PURPOSE: Laparoscopic pyeloplasty (LP) is gaining acceptance as a standard of care for the repair of ureteropelvic junction (UPJ) obstruction, with results comparable to those of open repair. However, it remains a technically challenging procedure requiring intracorporeal suturing skills. Recent reports have demonstrated equally effective results with robot-assisted laparoscopy with shorter operative times. We present our modified technique for daVinci robot-assisted LP. PATIENTS AND METHODS: From November 2002 to May 2004, 32 consecutive patients underwent LP with the daVinci robotic system for UPJ obstruction. Just prior to laparoscopy, 31 patients underwent retrograde pyelography and cystoscopic placement of a ureteral catheter just distal to the UPJ, which was prepared into the operative field. The remaining patient had an indwelling stent placed preoperatively. Three transperitoneal ports are placed for the robot. A fourth port is placed for retraction, suction, dissection, and suture passage by the bedside surgeon. This port was placed at McBurney's point in the first two patients and the subxiphoid area in the subsequent 30 patients. A ureteral stent was inserted retrograde intraoperatively with laparoscopic assistance after exchanging the ureteral catheter for a guidewire. A Jackson-Pratt drain was placed in all cases. RESULTS: All procedures were completed laparoscopically. Anderson-Hynes dismembered pyeloplasty was performed in 31 patients, while Fengerplasty was performed in 1 patient. The average operative time was 300 minutes (initial 12 procedures: 384 minutes; last 10 procedures: 197 minutes). The average blood loss was approximately 50 mL and the average hospital stay 1.1 days. A crossing vessel was present in 44% of the cases. Stone extraction was performed in 5 cases (23%) and kidney biopsy in 1 case. The only perioperative complications were one migrated stent, which was repositioned under sedation without sequelae and one urinary tract infection. Of the 18 patients with follow-up exceeding 6 months (average 10.3 months), 16 have improved drainage and function and are asymptomatic. One patient with flank pain has no evidence of obstruction. One with delayed, although improved, drainage is asymptomatic. CONCLUSIONS: The daVinci robot system can be used effectively for LP. Although initial operative times were long, there was a significant decrease after the first 12 cases. Having retrograde access to the ureter allows simple intraoperative stent placement. We found that the subxiphoid placement of the fourth port gave the bedside surgeon the optimal location for suction, dissection, and intracorporeal suture passage. This approach and technique have become standard in our treatment of UPJ obstruction.