55 research outputs found
Cost of simulation-based mastery learning for abdominal ultrasound
Get PDFBACKGROUND: Ultrasound is an essential diagnostic examination used in several medical specialties. However, the quality of ultrasound examinations is dependent on mastery of certain skills, which may be difficult and costly to attain in the clinical setting. This study aimed to explore mastery learning for trainees practicing general abdominal ultrasound using a virtual reality simulator and to evaluate the associated cost per student achieving the mastery learning level.METHODS: Trainees were instructed to train on a virtual reality ultrasound simulator until the attainment of a mastery learning level was established in a previous study. Automated simulator scores were used to track performances during each round of training, and these scores were recorded to determine learning curves. Finally, the costs of the training were evaluated using a micro-costing procedure.RESULTS: Twenty-one out of the 24 trainees managed to attain the predefined mastery level two times consecutively. The trainees completed their training with a median of 2h38min (range: 1h20min-4h30min) using a median of 7 attempts (range: 3-11 attempts) at the simulator test. The cost of training one trainee to the mastery level was estimated to be USD 638.CONCLUSION: Complete trainees can obtain mastery learning levels in general abdominal ultrasound examinations within 3 hours of training in the simulated setting and at an average cost of USD 638 per trainee. Future studies are needed to explore how the cost of simulation-based training is best balanced against the costs of clinical training.</p
Correction to: Understanding what matters most to patients in acute care in seven countries, using the flash mob study design
Get PDFFollowing publication of the original article [1], the authors identified an error in the author name of Ling Yan LEUNG. The incorrect author name is: L. E. U. N. G. Ling Yan The correct author name is: Ling Yan LEUNG The author group has been updated above and the original article [1] has been corrected.</p
Prospective investigation of serum anti-Müllerian hormone concentration in ovulatory intrauterine insemination patients: a preliminary study
No full textThis preliminary prospective study investigated serum anti-Müllerian hormone (AMH) through correlations to other basal parameters (123 patients) and according to ovarian response to 75 IU recombinant follicle-stimulating hormone (rFSH)/day (62 patients) in ovulatory patients' first rFSH treatment cycle before intrauterine insemination. Mean age of the patients was 33 years. Serum AMH significantly correlated to age (r=-0.38), antral follicle count (AFC) (r=0.68), ovarian volume (r=0.40), FSH (r=-0.31), (P2-3 mature follicles or dose reduction). There was a significant trend over response groups for body weight (P=0.005), body mass index (P=0.035), AFC (P=0.031) and FSH (P=0.001). Serum AMH median (IQR) was 10.6 pmol/l (6.9-18.2) in the 23 patients who achieved an ongoing pregnancy versus 10.5 (5.9-17.2) in the 100 non-pregnant women. Serum AMH may not be the best marker of the ovarian response in these patients
Exploring training needs of newly graduated medical doctors to inform the undergraduate simulation-based curriculum: a national Delphi consensus study
No full textPurpose: Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors.Methods: We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures.Results: In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture.Conclusion: Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education.Purpose: Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors.Methods: We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures.Results: In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture.Conclusion: Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education
Video-based robotic surgical action recognition and skills assessment on porcine models using deep learning
Get PDFOBJECTIVES: This study aimed to develop an automated skills assessment tool for surgical trainees using deep learning.BACKGROUND: Optimal surgical performance in robot-assisted surgery (RAS) is essential for ensuring good surgical outcomes. This requires effective training of new surgeons, which currently relies on supervision and skill assessment by experienced surgeons. Artificial Intelligence (AI) presents an opportunity to augment existing human-based assessments.METHODS: We used a network architecture consisting of a convolutional neural network combined with a long short-term memory (LSTM) layer to create two networks for the extraction and analysis of spatial and temporal features from video recordings of surgical procedures, facilitating action recognition and skill assessment.RESULTS: 21 participants (16 novices and 5 experienced) performed 16 different intra-abdominal robot-assisted surgical procedures on porcine models. The action recognition network achieved an accuracy of 96.0% in identifying surgical actions. A GradCAM filter was used to enhance the model interpretability. The skill assessment network had an accuracy of 81.3% in classifying novices and experiences. Procedure plots were created to visualize the skill assessment.CONCLUSION: Our study demonstrated that AI can be used to automate surgical action recognition and skill assessment. The use of a porcine model enables effective data collection at different levels of surgical performance, which is normally not available in the clinical setting. Future studies need to test how well AI developed within a porcine setting can be used to detect errors and provide feedback and actionable skills assessment in the clinical setting.</p
Remission of nephrotic syndrome diminishes urinary plasmin content and abolishes activation of ENaC
No full textBackground: Urinary plasmin activates the epithelial Na + channel (ENaC) in vitro and may possibly be a mechanism of sodium retention in nephrotic syndrome (NS). This study used a paired design to test the hypothesis that remission of NS is associated with a decreased content of urinary plasmin and reduced ability of patients' urine to activate ENaC. Methods: Samples were collected during active NS and at stable remission from 20 patients with idiopathic NS, aged 9.1 ± 3.2 years. Plasminogen-plasmin concentration was measured with an enzyme-linked immunosorbent assay. Western immunoblotting for plasminogen-plasmin was performed in paired urine samples. The patch clamp technique was used to test the ability of urine to evoke an inward current on collecting duct cells and human lymphocytes. Results: The urinary plasminogen-plasmin/creatinine ratio was 226 [95 % confidence interval (CI) 130-503] μg/mmol in nephrotic urine versus 9.5 (95 % CI 8-12) μg/mmol at remission (p < 0.001). Western immunoblotting confirmed the presence of active plasmin in urine collected during active NS, while samples collected at remission were negative. Nephrotic urine generated an inward amiloride- and α 2-anti-plasmin- sensitive current, whereas the observed increase in current in urine collected at remission was significantly lower (201 ± 31 vs. 29 ± 10 %; p = 0.005). Conclusions: These findings support the hypothesis that aberrantly filtered plasminogen-plasmin may contribute to ENaC activation and mediate primary renal sodium retention during active childhood NS.</p
Additional file 1 of Cost of simulation-based mastery learning for abdominal ultrasound
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Simulation-based assessment of upper abdominal ultrasound skills
Get PDFBackground: Ultrasound is a safe and effective diagnostic tool used within several specialties. However, the quality of ultrasound scans relies on sufficiently skilled clinician operators. The aim of this study was to explore the validity of automated assessments of upper abdominal ultrasound skills using an ultrasound simulator.Methods: Twenty five novices and five experts were recruited, all of whom completed an assessment program for the evaluation of upper abdominal ultrasound skills on a virtual reality simulator. The program included five modules that assessed different organ systems using automated simulator metrics. We used Messick's framework to explore the validity evidence of these simulator metrics to determine the contents of a final simulator test. We used the contrasting groups method to establish a pass/fail level for the final simulator test.Results: Thirty seven out of 60 metrics were able to discriminate between novices and experts (p < 0.05). The median simulator score of the final simulator test including the metrics with validity evidence was 26.68% (range: 8.1-40.5%) for novices and 85.1% (range: 56.8-91.9%) for experts. The internal structure was assessed by Cronbach alpha (0.93) and intraclass correlation coefficient (0.89). The pass/fail level was determined to be 50.9%. This pass/fail criterion found no passing novices or failing experts.Conclusions: This study collected validity evidence for simulation-based assessment of upper abdominal ultrasound examinations, which is the first step toward competency-based training. Future studies may examine how competency-based training in the simulated setting translates into improvements in clinical performances
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Ptpn22 and Cd2 Variations Are Associated with Altered Protein Expression and Susceptibility to Type 1 Diabetes in Nonobese Diabetic Mice
No full textBy congenic strain mapping using autoimmune NOD.C57BL/6J congenic mice, we demonstrated previously that the type 1 diabetes (T1D) protection associated with the insulin-dependent diabetes (Idd)10 locus on chromosome 3, originally identified by linkage analysis, was in fact due to three closely linked Idd loci: Idd10, Idd18.1, and Idd18.3. In this study, we define two additional Idd loci—Idd18.2 and Idd18.4—within the boundaries of this cluster of disease-associated genes. Idd18.2 is 1.31 Mb and contains 18 genes, including Ptpn22, which encodes a phosphatase that negatively regulates T and B cell signaling. The human ortholog of Ptpn22, PTPN22, is associated with numerous autoimmune diseases, including T1D. We, therefore, assessed Ptpn22 as a candidate for Idd18.2; resequencing of the NOD Ptpn22 allele revealed 183 single nucleotide polymorphisms with the C57BL/6J (B6) allele—6 exonic and 177 intronic. Functional studies showed higher expression of full-length Ptpn22 RNA and protein, and decreased TCR signaling in congenic strains with B6-derived Idd18.2 susceptibility alleles. The 953-kb Idd18.4 locus contains eight genes, including the candidate Cd2. The CD2 pathway is associated with the human autoimmune disease, multiple sclerosis, and mice with NOD-derived susceptibility alleles at Idd18.4 have lower CD2 expression on B cells. Furthermore, we observed that susceptibility alleles at Idd18.2 can mask the protection provided by Idd10/Cd101 or Idd18.1/Vav3 and Idd18.3. In summary, we describe two new T1D loci, Idd18.2 and Idd18.4, candidate genes within each region, and demonstrate the complex nature of genetic interactions underlying the development of T1D in the NOD mouse model.Version of Recor
La inmunogenética más allá de la clínica: genes y patógenos que marcaron nuestra historia demográfica. 6 Cuarta época, año 2 (2018) septiembre-diciembre. Diario de Campo. Nombrar y contar. Visibilidad estadística de las poblaciones afromexicanas
No full textExiste un número de condiciones clínicas asociadas con determinadas ancestrías, entre las cuales destaca la relación entre ciertos padecimientos autoinmunes y la ancestría nativa americana. Sin embargo, resulta lógico pensar que la presencia de estos padecimientos no fue seleccionada positivamente en el pasado y que las variantes relacionadas con estas afecciones fueron ventajosas en otro escenario. Los grupos nativos americanos tienen su origen en las poblaciones asiáticas. Tras dejar su continente de origen, viajaron a través de América y se encontraron con nuevos ambientes, animales y plantas, y por ello se expusieron a nuevos retos inmunes. La diversidad inicial en distintos genes se vio sometida a nuevas presiones selectivas al enfrentarse y adaptarse a una gran cantidad de microorganismos, muchos de los cuales posiblemente nunca habían enfrentado. Un caso particular de esta diversidad se aloja en los genes del sistema HLA, los cuales, a pesar de estar en proximidad, parecerían haber seguido historias evolutivas distintas. La pregunta obligada es: ¿la diversidad restringida en estos genes es el resultado de uno o más eventos adaptativos en América anteriores al siglo XVI, o somos testigos de uno de los más recientes ejemplos de selección natural en la historia de las poblaciones humanas?Acuña-Soto, Rodolfo et al. (2000). “Large epidemics of hemorrhagic fevers in Mexico 1545-1815”. The American Journal of Tropical Medicine and Hygiene, 62 (6), pp. 733-739._____ (2002). “Megadrought and megadeath in 16th century Mexico”. Emerging Infectious Diseases, 8 (4), pp. 360-362._____ (2004). “When half of the population died: The epidemic of hemorrhagic fevers of 1576 in Mexico”. FEMS Microbiology Letters, 240 (1), pp. 1-5.Barquera, Rodrigo (2012). “El papel de la genética de poblaciones en la inmunología del trasplante en México”. Gaceta Médica de México, 148 (1), pp. 52-67.Belich, Mônica P. et al. (1992). “Unusual HLA-B alleles in two tribes of Brazilian Indians”. Nature, 357 (6376), pp. 326-329.Bortolini, Maria Cátira, y Francisco M. Salzano (1996). “mtDNA diversity analysis in Amerindians and other human populations – how different are they?” Revista Brasileira de Genética, 19 (3), pp. 527-534.Bos, Kirsten I. et al. (2014). “Pre-Columbian mycobacterial genomes reveal seals as a source of New World human tuberculosis”. Nature, 514 (7523), pp. 494-497.Bothamley, Graham H. et al. (1989). “Association of uberculosis and M. tuberculosis-specific antibody levels with hla”. Journal of Infectious Diseases, 195 (3), pp. 549-555.Buckle, Geoffrey C. et al. (2012). “Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010”. Journal of Global Health, 2 (1), p. 10401.Callaway, Ewen (2016). “Plant and animal DNA suggests first Americans took the coastal route”. Nature, 536 (7615), p. 138.Chaaithanya, Itta Krishna et al. (2013). “HLA class II allele polymorphism in an outbreak of chikungunya fever in Middle Andaman, India”. Immunology, 140 (2), pp. 202-210.Conde-González, Carlos J. et al. (1993). “Historical account of venereal diseases in Mexico”. Genitourinary Medicine, 69 (6), pp. 462-466.Crosby, Alfred W. (1976). “Virgin soil epidemics as a factor in the aboriginal depopulation in America”. The William and Mary Quarterly, 33 (2), pp. 289-299.Delgado, Julio C. et al. (2006). “Aspartic acid homozygosity at codon 57 of HLA-DQ beta is associated with susceptibility to pulmonary tuberculosis in Cambodia”. The Journal of Immunology, 176 (2), pp. 1090-1097.Dunstan, Sarah J. et al. (2014). “Variation at HLA-DRB1 is associated with resistance to enteric fever”. Nature Genetics, 46 (12), pp. 1333-1336.Escamilla-Tilch, Mónica et al. (2013). “Association of genetic polymorphism of hla-drb1 antigens with the susceptibility to lepromatous leprosy”. Biomedical Reports, 1 (6), pp. 945-949.Goldfeld, Anne E. et al. (1998). “Association of an HLA-DQ allele with clinical tuberculosis”. Journal of the American Medical Association, 279 (3), pp. 226-228.González-Galarza, Faviel F. et al. (2015). “Allele frequency net 2015 update: New features for HLA epitopes, KIR and disease and HLA adverse drug reaction associations”. Nucleic Acids Research, 43, (núm. Especial de bases de datos), pp. D784-D788.Hammer, Christian et al. (2015). “Amino acid variation in HLA class II proteins is a major determinant of humoral response to common viruses”. The American Journal of Human Genetics, 97 (5), pp. 738-43.Hershberg, Ruth et al. (2008). “High functional diversity in Mycobacterium tuberculosis driven by genetic drift and human demography”. PLOS Biology, 6 (12), p. e311.Khomenko, A. G. et al. (1990). “Tuberculosis in patients with various HLA phenotypes”. Tubercle, 71 (3), pp. 187-192Krause-Kyora, Ben et al. (2018). “Ancient DNA study reveals HLA susceptibility locus for leprosy in medieval Europeans”. Nature Communications, 9 (1), p. 1569.Lindo, John et al. (2016). “A time transect of exomes from a Native American population before and after European contact”. Nature Communications, 7, p. 13175.López Herráez, David et al. (2013). “Rheumatoid arthritis in Latin Americans enriched for Amerindian ancestry is associated with loci in chromosomes 1, 12, and 13, and the HLA class II region”. Arthritis and Rheumatology, 65 (6), pp. 1457-1467.Lutz, Charles T. (2014). “HLA BW4 and BW6 epitopes recognized by antibodies and Natural Killer cells”. Current Opinion in Organ Transplantation, 18 (4), pp. 436-441.Marr, John S., y James B. Kiracofe (2000). “Was the huey cocoliztli a haemorrhagic fever?”. Medical History, 44 (3), pp. 341-362.Monack, Denise M. et al. (2004). “Persistent bacterial infections: The interface of the pathogen and the host immune system”. Nature Reviews Microbiology, 2 (9), pp. 747-765.Moreno-Estrada, Andrés et al. (2014). “The genetics of Mexico recapitulates Native American substructure and affects biomedical traits”. Science, 344 (6189), pp. 1280-1285.Palafox, Damián et al. (2016). “Determinación de HLA en pacientes con Síndrome de Parry Romberg atendidos en el Servicio de Cirugía Plástica y Reconstructiva del Hospital General ‘Dr. Manuel Gea González’”. Cirugía Plástica Ibero-Latinoamericana, 42 (2), pp. 115-120.Parham, P. et al. (1997). “Episodic evolution and turnover of HLA-B in the indigenous human populations of the Americas. Tissue Antigens, 50 (3), pp. 219-232.Pedersen, Mikkel W. et al. (2016). “Postglacial viability and colonization in North America’s ice-free corridor”. Nature, 537 (7618), pp. 45-49.Peschken, Christine A., y John M. Esdaile (1999). “Rheumatic diseases in North America’s indigenous peoples”. Seminars in Arthritis and Rheumatism, 28 (6), pp. 368-391.Pons-Estel, Bernardo A. et al. (2004). “The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among ‘Hispanics’”. Medicine, 83 (1), pp. 1-17.Ramírez Gómez, L. A. et al. (2008). “Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children”. Lupus, 17 (6), pp. 596-604.Salo, Wilmar L. et al. (1994). “Identification of Mycobacterium tuberculosis DNA in a pre-Columbian Peruvian mummy”. Proceedings of the National Academy of Sciences of the United States of America, 91 (6), pp. 2091-2094.Salomé, Jenny von et al. (2007). “Full-length sequence analysis of the HLA-DRB1 locus suggests a recent origin of alleles”. Immunogenetics, 59 (4), pp. 261-271.Salzano, Francisco M. (2002). “Molecular variability in Amerindians: Widespread but uneven information”. Anais da Academia Brasileira de Ciências, 74 (2), pp. 223-263.Sanchez, Elena et al. (2010). “Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus”. Arthritis and Rheumatology, 62 (12), pp. 3722-3729.Sanchez, Elena et al. (2010). “Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus”. Arthritis and Rheumatology, 62 (12), pp. 3722-3729.Sanchez, Elena et al. (2010). “Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus”. Arthritis and Rheumatology, 62 (12), pp. 3722-3729.Sanchez, Elena et al. (2010). “Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus”. Arthritis and Rheumatology, 62 (12), pp. 3722-3729.Sanchez, Elena et al. (2010). “Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus”. Arthritis and Rheumatology, 62 (12), pp. 3722-3729.Single, Richard M. et al. (2007). “Global diversity and evidence for coevolution of KIR and HLA. Nature Genetics, 39 (9), pp. 1114-1119.Somolinos d’Ardois, Germán (1956 / 2015). “El manuscrito sobre el cocoliztli”. En Francisco Hernández [Obras completas, t. IV] pp. 475-480. México: UNAM.Spyrou, Maria A. et al. (2019). “Ancient pathogen genomics as an emerging tool for infectious disease research”. Nature Reviews Genetics, 20, pp. 323-340.Tamm, Erika et al. (2007). “Beringian standstill and spread of Native American founders”. PLoS One, 2(9), p. e829.Terán-Escandón, David et al. (1999) “Human leukocyte antigen-associated susceptibility to pulmonary tuberculosis: Molecular analysis of class II alleles by DNA amplification and oligonucleotide hybridization in Mexican patients. Chest, 115 (2), pp. 428-433.Terán-Escandón, David et al. (1999) “Human leukocyte antigen-associated susceptibility to pulmonary tuberculosis: Molecular analysis of class II alleles by DNA amplification and oligonucleotide hybridization in Mexican patients. Chest, 115 (2), pp. 428-433.Thornton, Russell (1997). “Aboriginal North American population and rates of decline, ca. a.d. 1500-1901”. Current Anthropology, 38, pp. 310-315.Vågene, Åshild J. et al. (2018). “Salmonella enterica genomes from victims of a major sixteenth-century epidemic in Mexico”. Nature Ecology and Evolution, 2 (3), pp. 520-528.Wang, Sijia et al. (2007). “Genetic variation and population structure in Native Americans”. PLOS Genetics, 3 (11), p. e185.Watkins, David I. et al. (1992). “New recombinant HLA-B alleles in a tribe of South American Amerindians indicate rapid evolution of MHC class I loci”. Nature, 357 (6376), pp. 329-333.Wirth, Thierry et al. (2008). “Origin, spread and demography of the Mycobacterium tuberculosis complex”. PLOS Pathogens, 4 (9), p. e1000160.Zhou, Zhemin et al. (2017). “Millennia of genomic stability within the invasive Para C lineage of Salmonella enterica”. Recuperado de https://www.biorxiv.org/content/early/2017/02/14/10575
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