50 research outputs found
Training and certification in dialysis access
No full textDecreasing and eliminating the gaps in knowledge, skills, and effective communication are the mainstays for a successful dialysis access training program curriculum and at the core of the human factors training philosophy. Many of these skills can be learned in the simulation environment. Education and training will reduce gaps in knowledge and technical skills, before exposing patients to procedure-related risk. For dialysis access, a reliable workplace environment depends upon a culture where safety and accountability are balanced to recognize the human contribution to success or failure in the complex care of patients with end-stage renal disease. Rigorous testing and certification adds value to the participants and validates the training program
Virtual reality: emerging role of simulation training in vascular access
No full textEvolving new technologies in vascular access mandate increased attention to patient safety; an often overlooked yet valuable training tool is simulation. For the end-stage renal disease patient, simulation tools are effective for all aspects of creating access for peritoneal dialysis and hemodialysis. Based on aviation principles, known as crew resource management, we place equal emphasis on team training as individual training to improve interactions between team members and systems, cumulating in improved safety. Simulation allows for environmental control and standardized procedures, letting the trainee practice and correct mistakes without harm to patients, compared with traditional patient-based training. Vascular access simulators range from suture devices, to pressurized tunneled conduits for needle cannulation, to computer-based interventional simulators. Simulation training includes simulated case learning, root cause analysis of adverse outcomes, and continual update and refinement of concepts. Implementation of effective human to complex systems interaction in end-stage renal disease patients involves a change in institutional culture. Three concepts discussed in this article are as follows: (1) the need for user-friendly systems and technology to enhance performance, (2) the necessity for members to both train and work together as a team, and (3) the team assigned to use the system must test and practice it to a proficient level before safely using the system on patients
Training in dialysis access - charting future success
No full textPurpose: Medical education and training in dialysis access skills remains complex and inadequate as learners come from diverse backgrounds and from various specialties so that appropriate training is limited. As a result, a system of progressive education including live lectures, and hands on training has emerged, but there is controversy as to what constitutes the best educational model. Methods: Presently there is no recognized or structured training in vascular access during residency or fellowships. Here we present a model of dialysis access training for beginner to advanced surgeons. Results: A structured hands-on and didactic surgery training certification course consisting of a one week curriculum with 49 hours of ACCME credit hours has been in effect for one year. The learning impact and the performance outcome are high but with limited attendance capacity. Pre- and post- training test results attest to training effectiveness. To increase access, an off-site training curriculum has been initiated, entailing 1-2 days (8-15 credit hours) consisting of didactic lectures and surgical training. This teaching module has moderate learning impact for 50-100 attendees. Finally, a tiered, web-based training curriculum (10 ACCME credit hours) can accommodate an unlimited number of learners, but has a lower skills learning impact. Conclusions: The future dialysis access training must also accommodate learners with diverse individual backgrounds, and different levels of professional (skill) development. To be effective and accessible, a variety of educational system, for example on site or web based is needed. Collaborative initiatives for global dialysis access training are currently underway
Peritoneal dialysis access : open versus laparoscopic surgical techniques
No full textAim: To outline pros and cons with the open and laparoscopic techniques when placing peritoneal dialysis (PD) catheters. Background: Controversy exists regarding which technique, the open and laparoscopic, if any, is superior to the other. In addition, there is the question of which approach is best in rescuing malfunctioning PD catheters. Results: Rather than promoting one doctrine fits all, philosophically, doing the right thing for the patient by specific criteria is ethically the better model. These specific selection criteria include patient characteristics, the team's skills and knowledge and institutional resources and commitment. Also, the sophistication of a PD unit for training and monitoring of patients is crucial for successful outcomes. Open paramedian and two laparoscopic approaches are described in detail, outlining advantages and disadvantages of each, with suggestions when one method is preferred. Conclusions: In general, the laparoscopic technique is associated with longer operative times, higher costs and the need to utilize general anesthesia. It is, however, the preferred method when rescuing malfunctioning catheters and may increase the PD patient population in patients with previous abdominal surgeries. The dialysis access surgeon should be familiar with both open and laparoscopic techniques and appropriately choose the ideal method based upon the individual patient and institutional resources
Closing the loop: A model for inter-institutional collaboration through delivering formative assessment in large, first-year STEM classes
No full textWhen students start their tertiary studies they move into a new world which differs in many ways from their prior experiences, including the way they were taught, access to faculty, learning environments, class sizes, expectations of independence and time management (Torenbeek, 2011). The first year experience (FYE) has become a pivotal focus for institutional programs that recognize that many students struggle in this transition. Such programs aim to improve student retention in tertiary studies through provision of orientation and mentoring activities. These initiatives have become widespread and are typically informed by key research in the field in terms of transition pedagogies (Kift, 2009; Kift, 2010; Lawrence, 2005) and student engagement and retention (Kuh, 2008; Carini, 2006; Tinto, 1987; Tinto, 2005)
Light scattering on the high-temperature superconductors
No full textThe high temperature superconductors have been examined by the technique of Raman scattering in several limits: the insulating phase, the normal and superconducting state of the superconducting phase, and an optically induced metastable phase. In all cases, the analysis and proposed phenomenological models involved either an examination of the inelastic background scattering or the phonon excitation spectrum.Specifically, the character, temperature dependence, critical temperature dependence and the copper-oxygen covalency dependence of the inelastic background scattering has been studied in all three phases. Analysis of the superconducting phase reveals a marginal Fermi-liquid like character of the electronic polarizability, and a decidedly non-traditional shift of the scattering intensity of the electronic excitations at low temperature. On removing oxygen, the system passes through a metal-insulator transition and the inelastic background becomes dominantly magnetic in origin.Examinations of the 'allowed' Raman active phonons in the superconducting phase expose a strong coupling of two modes to the background electronic excitation spectrum, and a dramatic renormalization of these modes below T\sb{\rm c}. Further, two sharply resonant Raman 'forbidden' modes can be bleached out of the spectrum at low temperature with a sufficiently high laser dosage. A transition from this optically induced metastable state to the normal state occurs on warming the crystal back to room temperature. On reducing the oxygen concentration, the coupling strength of the two asymmetric phonons diminishes rapidly, the renormalization effects vanish, and the compound no longer exhibits metastability.Made available in DSpace on 2011-05-07T13:03:07Z (GMT). No. of bitstreams: 2
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Simulation training for vascular access interventions
No full textTraining and learning in the field of access for dialysis, including peritoneal and hemodialysis and access for oncologic patients, is well suited for the use of simulators, simulated case learning, and root cause analysis of adverse outcomes and team training. Simulators range over a wide spectrum from simple suture learning devices, inexpensive systems for venous puncture simulation, such as a turkey breast or leg with a pressurized tunneled rubber or graft conduit, to sophisticated computer designed simulators to teach interventional procedures such as vascular access angiogram, balloon angioplasty and stent placing. Team training capitalizes on the principles used in aviation, known as Crew Resource Management (CRM) or Human Factor (HF). The objectives of team training are to improve communication and leadership skills, to use checklists to prevent errors, to promote a change in the attitudes towards vascular access from learning through mistakes in a non-punitive environment, to impacting positively the employee performance and to increase staff retention by making the workplace safer, more efficient and user-friendly
The vertically integrated projects (VIP) program : leveraging faculty research interests to transform undergraduate STEM education
Get PDFThe Vertically-Integrated Projects (VIP) Program is an education program that operates in a research and development context. Undergraduate students that join VIP teams earn academic credit for their participation in discovery and design efforts that assist faculty and graduate students with research and development issues in their areas of technical expertise. The teams are: multidisciplinary – drawing students from across campus; vertically integrated – maintaining a mix of sophomores through PhD students each semester; and long-term – each undergraduate student may participate in a project for up to three years. The continuity, technical depth, and disciplinary breadth of these teams enable the completion of projects of significant benefit to faculty members’ research programs. We compare the implementations and success of VIP Programs at five different institutions by a variety of criteria, including: origin and type of implementation strategy; number of disciplines involved; type of institution; implementation in the curriculum; resources and support available; growth of the program; grading/assessment strategy and tools; relationship with other discovery and design programs; software tools for program administration; number of students and faculty involved; etc. While programmatic variations and support have a marked effect on the success of VIP at each institution, its implementation in the curriculum and the ease of scheduling and timetabling teams stand out as two of the most important issues for every VIP site. The common slow pace of curricular change and the variability of curricular implementations across disciplines and institutions, lead to specific recommendations and strategies for future growth and dissemination of the VIP Program
