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MedEdPORTAL : the Journal of Teaching... 2022Procedural training is a universal concern amongst pediatric residents and their teachers. We developed and implemented formative assessments to generate direct and...
INTRODUCTION
Procedural training is a universal concern amongst pediatric residents and their teachers. We developed and implemented formative assessments to generate direct and indirect procedural feedback. We analyzed changes in residents' perceived procedural knowledge, skills, confidence, and entrustment.
METHODS
Senior pediatric residents rotating in the pediatric emergency department participated in video-recorded formative assessments of informed consent OSCEs and simulated toddler forehead laceration repair and infant lumbar puncture. Residents reflected on their perceived procedural knowledge, skills, confidence, and entrustment through Likert and entrustment scales. Secondary outcomes of formative assessment completion rates and proportions of procedures performed by pediatric residents tracked feasibility and potential clinical impact, respectively.
RESULTS
Including the pilot period, 89% of residents (31 out of 35) received direct and indirect procedural feedback. Perceived composite competency and entrustment improved for laceration repair (competency: from 3.1 to 3.9, < .001; entrustment: from 4.0 to 5.1, < .001) and lumbar puncture (competency: from 3.5 to 4.0, < .001; entrustment: from 4.6 to 5.6, = .001). We observed an increase in the proportion of clinical laceration repairs (11% [97 out of 885] vs. 23% [218 out of 946], < .001) and lumbar punctures (23% [12 out of 54] vs. 41% [21 out of 52], = .05) performed by pediatric residents.
DISCUSSION
Integrating feasible procedural formative assessments into the pediatric emergency department rotation had a positive impact on senior pediatric residents' perceptions of their procedural knowledge, skills, confidence, and entrustment and was associated with increased procedural engagement.
Topics: Clinical Competence; Emergency Service, Hospital; Humans; Internship and Residency; Lacerations; Pediatrics
PubMed: 35892044
DOI: 10.15766/mep_2374-8265.11265 -
Annals of the Royal College of Surgeons... Nov 2017Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We...
Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We identify patient demographics, morbidity risk factors, injury severity and management options. Materials and methods This retrospective study involved analysing databases and hardcopy notes for patients admitted with pretibial lacerations to Addenbrooke's Hospital, January to December 2012. Microsoft Excel and Fishers exact test were used to analyse the data with a P-value of less than 0.05 representative of statistical significance. Information on patient demographics, site of lesion, preoperative symptoms, management, operative details and clinical outcomes were collected. Results A total of 36 patients were identified; the mean age was 79 years (± 16 years, 1 standard deviation) with a three to two female to male preponderance; 57% of injuries were caused by mechanical fall, 33% traumatic blunt impact and 7% road traffic accidents. American Society of Anesthesiologists physical status classification was 43% level III, 40% II, 9% I and 9% IV. Dunkin classification of severity was 33% grade III, 30% grade I, 24% grade IV and 12% grade II. Median inpatient duration was 11 days for surgically managed compared with 15 days for conservatively managed patients. Discussion Pretibial lacerations tend to affect the elderly. Management is compounded by polypharmacy and comorbidities. If inadequately managed, such injuries can adopt characteristics of chronic wounds, with lengthy inpatient stays. Surgical intervention may be appropriate where injuries are severe and the patient stable enough for theatre. Conclusions We believe that surgical management with autologous tissue repair, with minimal delay between presentation and theatre, is warranted for extensive injuries wherever possible, with conservative management used for predominantly less extensive pretibial lacerations.
Topics: Accidental Falls; Aged; Aged, 80 and over; Debridement; Female; Humans; Injury Severity Score; Lacerations; Leg Injuries; Length of Stay; Male; Middle Aged; Retrospective Studies; Skin Transplantation
PubMed: 29022785
DOI: 10.1308/rcsann.2017.0137 -
International Wound Journal Jun 2020A recently published model that predicted the risk of skin tears in older adults was compared with seven additional published models. Four models were excluded because...
A recently published model that predicted the risk of skin tears in older adults was compared with seven additional published models. Four models were excluded because of limitations in research design. Four models were compared for their relative predictive performance and accuracy using sensitivity, specificity, and the area under the curve (AUC), which involved using receiver-operating characteristic analysis. The predictive ability of the skin tear models differed with the AUC ranging between 0.673 and 0.854. Based on the predictive ability, the selection of models could lead to different clinical decisions and health outcomes. The model, which had been adjusted for potential confounders consisted of five variables (male gender, history of skin tears, history of falls, clinical skin manifestations of elastosis, and purpura), was found to be the most parsimonious for predicting skin tears in older adults (AUC 0.854; 81.7% sensitivity; 81.4% specificity). Effective models serve as important clinical tools for identifying older individuals at risk of skin tears and can better direct more timely and targeted prevention strategies that improve health outcomes and reduce health care expenditure.
Topics: Aged; Aged, 80 and over; Female; Humans; Lacerations; Male; Middle Aged; Models, Statistical; Predictive Value of Tests; ROC Curve; Risk Factors; Skin
PubMed: 32173997
DOI: 10.1111/iwj.13340 -
Canadian Journal of Rural Medicine :... 2020
Topics: Humans; Lacerations; Nails; Surgical Procedures, Operative
PubMed: 32235109
DOI: 10.4103/CJRM.CJRM_83_19 -
Revista Da Associacao Medica Brasileira... Aug 2022The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in...
OBJECTIVE
The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones.
METHODS
The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups.
RESULTS
There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524).
CONCLUSIONS
It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.
Topics: Humans; Lacerations; Lithotripsy; Retrospective Studies; Treatment Outcome; Ureteral Calculi; Ureteroscopy
PubMed: 36134836
DOI: 10.1590/1806-9282.20220237 -
PeerJ 2022, a tropical sea anemone known as Aiptasia, is a tractable model system for studying the cellular, physiological, and ecological characteristics of...
, a tropical sea anemone known as Aiptasia, is a tractable model system for studying the cellular, physiological, and ecological characteristics of cnidarian-dinoflagellate symbiosis. Aiptasia is widely used as a proxy for coral-algal symbiosis, since both Aiptasia and corals form a symbiosis with members of the family Symbiodiniaceae. Laboratory strains of Aiptasia can be maintained in both the symbiotic (Sym) and aposymbiotic (Apo, without algae) states. Apo Aiptasia allow for the study of the influence of symbiosis on different biological processes and how different environmental conditions impact symbiosis. A key feature of Aiptasia is the ease of propagating both Sym and Apo individuals in the laboratory through a process called pedal laceration. In this form of asexual reproduction, small pieces of tissue rip away from the pedal disc of a polyp, then these lacerates eventually develop tentacles and grow into new polyps. While pedal laceration has been described in the past, details of how tentacles are formed or how symbiotic and nutritional state influence this process are lacking. Here we describe the stages of development in both Sym and Apo pedal lacerates. Our results show that Apo lacerates develop tentacles earlier than Sym lacerates, while over the course of 20 days, Sym lacerates end up with a greater number of tentacles. We describe both tentacle and mesentery patterning during lacerate development and show that they form through a single pattern in early stages regardless of symbiotic state. In later stages of development, Apo lacerate tentacles and mesenteries progress through a single pattern, while variable patterns were observed in Sym lacerates. We discuss how Aiptasia lacerate mesentery and tentacle patterning differs from oral disc regeneration and how these patterning events compare to postembryonic development in , another widely-used sea anemone model. In addition, we demonstrate that Apo lacerates supplemented with a putative nutrient source developed an intermediate number of tentacles between un-fed Apo and Sym lacerates. Based on these observations, we hypothesize that pedal lacerates progress through two different, putatively nutrient-dependent phases of development. In the early phase, the lacerate, regardless of symbiotic state, preferentially uses or relies on nutrients carried over from the adult polyp. These resources are sufficient for lacerates to develop into a functional polyp. In the late phase of development, continued growth and tentacle formation is supported by nutrients obtained from either symbionts and/or the environment through heterotrophic feeding. Finally, we advocate for the implementation of pedal lacerates as an additional resource in the Aiptasia model system toolkit for studies of cnidarian-dinoflagellate symbiosis.
Topics: Animals; Sea Anemones; Symbiosis; Lacerations; Anthozoa; Environment; Dinoflagellida
PubMed: 35047238
DOI: 10.7717/peerj.12770 -
BMC Pregnancy and Childbirth Dec 2022Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can...
INTRODUCTION
Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, we aimed to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy.
METHODS
We conducted a nationwide register-based study using data from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage changes (APC) with 95% Confidence Intervals (95% CI). Poisson regression models were fitted to estimate whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (aRR) and their respective 95% CI were obtained.
RESULTS
From 908,999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. Among women with non-instrumental deliveries and no episiotomy SPT decreased from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Time-trends in potential risk factors did not explain the observed increase in SPT. Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries.
CONCLUSIONS
Our findings suggest that episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.
Topics: Pregnancy; Female; Humans; Portugal; Obstetric Labor Complications; Perineum; Episiotomy; Delivery, Obstetric; Lacerations; Risk Factors
PubMed: 36577964
DOI: 10.1186/s12884-022-05314-6 -
Epidemiologia E Servicos de Saude :... 2024To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in...
OBJECTIVE
To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil.
METHODS
This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models.
RESULTS
Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome.
CONCLUSION
The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations.
MAIN RESULTS
Prevalence of self-reported perineal laceration was 49.5%. Being in the adolescent age group, primiparity, excessive gestational weight and the Kristeller maneuver were risk factors associated with the event.
IMPLICATIONS FOR SERVICES
Studying self-reported prevalence of perineal laceration supports new care practices, highlights the prevention of risk factors considered modifiable and confirms the need to follow current guidelines.
PERSPECTIVES
New national studies are needed comparing prevalence of self-reported perineal laceration with that recorded in medical records in order to support care practices and public obstetric policies.
Topics: Pregnancy; Adolescent; Infant, Newborn; Female; Humans; Lacerations; Cross-Sectional Studies; Brazil; Prevalence; Perception
PubMed: 38597528
DOI: 10.1590/S2237-96222024V33E2023621.EN -
International Urogynecology Journal Jul 2021The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published... (Review)
Review
INTRODUCTION AND HYPOTHESIS
The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published literature and describe management and repair techniques in a case series.
METHODS
A literature search was carried out. All results were screened and reviewed. Rectal buttonhole tears following vaginal delivery between April 2012 and January 2020 in our institution were identified. Repair technique and post-operative management were recorded.
RESULTS
There were nine published case reports (four instrumental deliveries, two vaginal breech and three normal vaginal deliveries). Four case reports described a two-layer closure and five described a three-layer closure. Two cases were repaired in collaboration with colorectal surgeons. All nine cases made an uneventful recovery. We identified three patients with buttonhole tears all of whom had instrumental deliveries. A colorectal surgeon repaired the tear in two layers in one case, and an obstetrician performed the repair in the other two cases, one in three layers and the other in two layers. One patient had a de-functioning stoma at a later date due to a second breakdown of the recto-vaginal fistula repair.
CONCLUSION
Buttonhole tears are rare but techniques of repair vary. Most cases reviewed had an uneventful recovery after repair. We provide standardised steps for repair and management of isolated rectal buttonhole tears along with a video demonstrating the repair technique in an animal tissue (pig) model.
Topics: Anal Canal; Animals; Delivery, Obstetric; Female; Humans; Lacerations; Obstetric Labor Complications; Obstetrics; Pregnancy; Rectal Diseases; Swine
PubMed: 32930849
DOI: 10.1007/s00192-020-04502-2 -
International Journal of Gynaecology... Dec 2022To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth.
OBJECTIVE
To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth.
METHODS
Retrospective cohort study. The perineal outcomes of secundiparous women with history of previous (first) delivery in one of three categories: failed operative vaginal delivery (FOVD) and second-stage emergency cesarean section (EmCS); elective cesarean section (ElCS), and vaginal delivery (VD) with intact perineum, were compared with a control primiparous group.
RESULTS
The percentage obstetric anal sphincter injuries (OASIS)at first vaginal delivery was 17.3% (n = 9) after previous FOVD+EmCS, 12.9% (n = 18) after previous ElCS, and 0.6% (n = 9) after previous VD maintaining an intact perineum, compared with 6% (n = 1193) in the control primiparous group of women. Multivariate regression analysis demonstrated that previous FOVD+EmCS and ElCS were associated with a statistically significant increased risk of OASIS of 180% and 110% when compared with control (odds ratio [OR] 2.80; 95% confidence interval [CI] 1.35-5.78 and OR 2.10; 95% CI 1.27-3.48, respectively). Previous VD with intact perineum was associated with a statistically significantly reduced risk of OASIS (OR 0.09; 95% CI 0.04-0.17).
CONCLUSIONS
Previous FOVD+EmCS and ElCS were associated with increased risk of OASIS in subsequent vaginal delivery compared with control, whereas previous VD with intact perineum was associated with decreased risk.
Topics: Female; Pregnancy; Humans; Perineum; Cesarean Section; Anal Canal; Retrospective Studies; Delivery, Obstetric; Risk Factors; Obstetric Labor Complications; Lacerations
PubMed: 35426118
DOI: 10.1002/ijgo.14218