Impact of physician training level on emergency readmission within internal medicine

The Economy of Motion for Laparoscopic Ball Clamping Surgery: A Feedback Educational Tool

The Ball Clamping module of the Laparoscopic Surgery Training Box involves the transfer of beads across the training board using laparoscopic tools. Fundamentals of Laparoscopic Surgery (FLS) requires practitioners to move their hands at as short a distance as possible to perform the functions in the shortest amount of time. This study introduces a feedback tool that presents to the student, after attempting their exam, the right direction (step by step) of obtaining the optimal pathway for minimizing distance traveled in the Ball Clamping Module of the Laparoscopic Surgery Training Box. The shortest distance tour for the ball clamping task is determined using the Traveling Salesman Model (TSM). A sensitivity analysis is conducted to assess the model's applicability to different types and settings of trainer boxes.•Find the best sequence of points resulting in the shortest distance tour for the ball clamping task.•The effects of adding or removing columns from the box cannot be intuitively predicted.

The efficacy of the new medical internship management network system

With the increasing number of medical students and scattered host hospitals, the traditional clinical internship management system has been falling behind. Thus, we have independently developed a new clinical practice management system based on the browser/server structure.We aim to evaluate the efficacy of the new medical management system on the quality of the internship and survey the users' satisfaction.This study was conducted on the students of Second Clinical Medical College of Southern Medical University, including 672 interns (non-user group) who had not used the system and 315 users (user group). We analyzed the scores of their theoretical knowledge and clinical skills before and after the internship, which served as the quantitative standards for evaluating the efficacy of the system. User satisfaction surveys were also conducted, including by interns, clinical teachers, and teaching administrators.An analysis of scores showed that the user group had more significant improvement in both clinical knowledge and skills than the non-user group after the internship. Significant improvement was found in the user group, while there was a slight difference in the non-user group. A total of 310 students responded to the satisfaction questionnaires effectively, most of whom agreed with the system's benefits of learning theoretical knowledge (98.1%, n = 304) and clinical skills (93.9%, n = 291). Additionally, 115 clinical teachers and 27 teaching administrators were selected using a random sampling method for the survey. The results showed that 96.3% of the teachers considered the system to be helpful for improving teaching quality, and 92.6% administrators thought it was useful for implementing management. Over 90% of the participants in the 3 user groups reported a strong satisfaction of the system.With high level of user satisfaction, this system helps to strengthen the management for interns and improves the medical knowledge and skills of interns. Hence, it could be widely used in medical colleges and even in other fields.

The effectiveness of the internship in meeting established learning objectives: A qualitative study

OBJECTIVE

To identify and explore variations in intern (Postgraduate Year 1 doctors) exposure to clinical activities defined by an established early postgraduate curriculum within the contemporary health service environment.

METHODS

A mixed methods study was undertaken in seven health services comprising (1) a questionnaire regarding interns' exposure to a range of clinical activities within a two-year early post-graduate curriculum and (2) group interviews with intern supervisors and managers to explore barriers and facilitators of interns' clinical exposure.

RESULTS

One hundred and eleven interns completed the questionnaire and seventeen intern supervisors and managers participated in group interviews. Interns' exposure to early postgraduate curriculum activities varied significantly, with participation in patient emergency management and procedures being undertaken less frequently than interns wished. These findings were consistent across different regional settings. Of three mandatory terms, exposure to curriculum activities was greater in medicine and emergency medicine than in surgery.

CONCLUSIONS

Junior doctors' participation within the complex contemporary health service environment is constrained by barriers relating to clinical governance frameworks and health system performance, particularly in high-risk clinical activities. Solutions will require structural approaches to internship reform to ensure that placements provide the necessary safe clinical experiences required for intern training.

The long-term outcome after treatment for patients with tibial fracture treated with intramedullary nailing is not influenced by time of day of surgery and surgeon experience

INTRODUCTION

The objective of the present study was to evaluate the relationship between clinical outcome and time of day of surgery and experience level of the surgeon. Secondly, we examined the relationship between the length of hospital stay and the time of day of surgery.

METHODS

This retrospective cross-sectional cohort design study included patients treated with intramedullary nailing at Aalborg University Hospital from 1998 to 2008 after tibial shaft fractures (N = 294). At follow-up, the participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS). Age, sex, complications, length of hospital stay, start time of surgery, and education level of surgeons were recorded.

RESULTS

The long-term analysis of the KOOS assessment shows no significant association between time of day of surgery and the level of surgeon experience. There was no difference in complication rates between time of day of surgery and the level of surgeon experience. The secondary outcome analysis showed an estimated increased risk of 25 % (p = 0.001), for a longer length of hospital stay when operated by a trainee at night-hours compared to day-hours, and an estimated increased risk of 17 % (p = 0.002) for longer length of stay, when operated at day-hours by a trauma surgeon compared to a trainee.

CONCLUSION

Complication rates and KOOS outcome after surgery with intramedullary nailing were not influenced by time of day of surgery and experience level of the surgeon. The lengths of hospital stay increase significantly when surgery is performed at night by trainee surgeons, but not when performed by trauma surgeons.

Health services management and research at Nordic School of Public Health

In Anglo-Saxon countries the subject of health services research has long been an important academic theme. In the Nordic countries, however, this research and training area has been limited and partly hidden by integration into various other sections at universities and colleges. In this respect the Nordic School of Public Health was an exception, as the provision of managerial skills to healthcare professionals and persons working with public health was the backbone of the school during all 60 years. A variety of research in health services management, as well as publications of text books, accompanied the presented courses. Several of the scholars have earned important positions in international networks and editorial boards, as well as in boards for assessments of research grants. In the near future, this academic field will require alternative support.

A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge

BACKGROUND & AIMS

Reducing rapid readmission of patients after discharge could improve quality of treatment and reduce costs. Little is known about clinical predictors of early readmission for acute pancreatitis (AP). We developed a strategy to identify and stratify patients with AP at risk for readmission within 30 days of discharge.

METHODS

We derived and validated a model in a cohort of patients hospitalized with AP from June 2005-October 2009. Early readmission was defined as admission to the hospital or reevaluation in the emergency department within 30 days of discharge. The cohort was divided into a derivation cohort (admitted June 2005-December 2007, n = 248) and a validation cohort (admitted January 2008-October 2009, n = 198). A weighted scoring system was developed using logistic regression for the prediction of early readmission. Accuracy was assessed by area under the receiver-operator characteristic (ROC) curve analysis.

RESULTS

Of the total patients, 21% (92/446) had early readmission. Multivariable analysis identified the following discharge characteristics as independent risk factors for early readmission: gastrointestinal symptoms, eating less than a solid diet, pancreatic necrosis, treatment with antibiotics, and pain (P < .05). Weighted risk scores stratified patients into groups of low, moderate, and high risk for early readmission: 4%, 15%, and 87%, respectively, in the derivation cohort and 5%, 18%, and 68%, respectively, in the validation cohort. Area under the ROC curve demonstrated an accurate prediction (c-statistic = 0.83).

CONCLUSIONS

We created a scoring system that accurately predicts which patients with AP have high and low risk of readmission within 30 days of discharge.