Background/Aim: It is generally not probable to employ a radiologist or an experienced physician for interpreting radiological images at emergency services. The importance of telemedicine has grown, especially during the coronavirus 2019 pandemic. There are a few studies on cranial tomography image transfer and correct evaluation rate with smartphones in the literature. This study aims to evaluate the effectiveness of smartphones for diagnosing mortal pathologies such as skull fractures and intracranial hemorrhages compared to the original images on LED displays of radiology terminals. Methods: This methodological study was designed to validate smartphones' usefulness in assessing cranial computerized tomography scans in emergency cases. Four sets of CT scans, each containing 10 case samples in four diagnostic groups, subarachnoid hemorrhage, subdural hemorrhage, epidural hemorrhage, and bone fractures, and a set of 10 non-pathological CT scans were evaluated first on 6.1-inches smartphone display for 1 minute, and then on the 17-inches LED display again for 1 minute. The internal camera of the smartphone was used to capture the image before assessments. Results: A total of 12 neurosurgeons evaluated 50 CT scan images both on smartphones and LED displays. The overall accuracy between both methods ranged between 80%-100% for subarachnoid and epidural hemorrhage and bone fractures, and between 90%-100% for subarachnoid hemorrhage and non-pathological CT scans. The individual kappa coefficients of neurosurgeons ranged between 0.725 to 1.0 (P
The quality of cardiopulmonary resuscitation (CPR) is the main determinant of survival in cardiac arrest, so high-quality CPR (HQ-CPR) from bystanders is essential. The best instructional model for HQ-CPR performed by bystanders remains under investigation, and an instructional model’s effect on various learner types is unknown. This study examined the immediate effect of a brief, blended instructional design that combines deliberate practice (DP) with real-time feedback (RTF) on the booster training of intern doctors (IDs) and acute care providers (ACPs) as well as on the skills acquisition training of lay rescuers (LRs). This cohort crossover study was conducted in a university-affiliated hospital in January 2020. Just-in-time training on HQ-CPR that featured a popular song was provided to IDs (n = 24), ACPs (n = 29), LRs (n = 25); groups performed one-minute cardiac compressions twice, without RTF and with verbal coaching, followed by debriefing, and then with only RTF. The impact of RTF on depth, rate, compression quality (CQ), and recoil was assessed. RTF significantly improved depth, rate, CQ, and recoil (p < 0.001). Among the LRs, the depth was 0.2 millimeters below the lower cutoff. Without RTF, the previously trained IDs and ACPs tended to perform inadequately faster and deeper compressions, while the untrained LRs performed slower, shallow compressions. DP combined with RTF yielded a significant immediate effect on the HQ-CPR training outcomes of all learner types.
Objective: Reports to legal authorities must be made for a variety of patients who present to emergency departments (EDs). This study summarises paediatric cases reported with a temporary legal form from our ED and reviews the literature on this topic with reasons and possibilities. Material and Methods: Charts were reviewed of all patients presenting to the university ED up to 18 years of age who were declared to hospital police as a legal case between January 1, 2008 and December 31, 2009. Demographic and clinical details were recorded. SPSS version 12 was used for statistical analysis. Results: During the study period, 889 paediatric cases (mean age 8±5 years, 58% male) were referred to the hospital police as cases requiring legal action. The categories of injuries/events to patients due to the chief complaint were as follows: poisonings in 28% (n=255), falls in 23% (n=208), and traffic accidents in 16% (n=144). Over half (55%) of patients were discharged home while 45% were admitted: 13% to paediatric surgery, 8% to neurosurgery, and 7% to paediatrics. Conclusion: Patients who were admitted to the emergency service due to falls could be reported to the legal authorities by doctors as a result of a suspicion of child abuse, neglect or any kind of physical violence instead of simple reasons due to the findings of the patients. It was observed that patients who had no significant physical findings or a history could not be reported. (JAEM 2013; 12: 113-7)
Background/Aim: Point-of-care ultrasound is a focused exam. It is a method that can be easily repeated by clinicians, especially as it aims for answering specific questions. The current study aimed to evaluate how successfully the students could learn Focused Assessment with Sonography for Trauma (FAST) and the permanence of the education after the simulation-based training. Methods: This study was conducted with final year medical students in Acibadem Mehmet Ali Aydinlar University Hospital Emergency Department and Acibadem University Center of Advanced Simulation and Education. The FAST course was taught by emergency physician specialists. After 2 h of theoretical training, a 3-h hands-on small group practical session was held face-to-face in which the students performed FAST scans with a CAE Vimedix high-fidelity simulator. After ultrasound training, the participants were separated into three groups of 20 each. One group was considered a control group in which they did not perform FAST on any real patient during the emergency medicine rotation (Group A). Group B performed FAST on 20 real patients, and Group C performed the technique on 40 real patients in the emergency department. A re-evaluation exam was done six months later. Results: This study included 60 participants. At the end of the first evaluation, the mean scores of Groups A (Control Group), B, and C were 6.05 (1.72), 6.05 (1.27), and 5.55 (13.2), respectively. The second evaluation results were 2.51 (0.51) with P < 0.001) and 8.84 (0.73) with a P < 0.001, and 9.71 (0.27) with P < 0.001, respectively. Conclusion: The long-term memory retention of the training presented in the simulation alone may be controversial. In our study, the take-home point is that for 2 h of theoretical lectures and 3 h of simulation training to be permanently retained, practicing the technique with at least 20 patients is needed.
Preseptal cellulitis is a commonly observed inflammation of the eyelid and the surrounding skin in pediatric patients, especially after a minor trauma. Although preseptal cellulitis is generally associated with a more favorable prognosis, it is vital to remember that all orbital infections require prompt diagnosis and treatment because of the risk of severe complications. Inadequate or failure to adhere to the treatment plan and unmet hygiene standards can lead to severe complications; therefore, diligent follow-up care should be undertaken by both the physician and the patient.
Abstract The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of video feedback by comparing the improvement in procedural performance when trainees received self-video feedback (trainees review their performance alone) and expert-assısted video feedback (trainees review their performance while an emergency physician provides additional feedback). This study was performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. Following the educational presentation and the best practice video, trainees were randomized into two groups (self video-feedback and expert assisted video-feedback). They performed the cricothyroidotomy before and after the feedback, The procedures were recorded and scored. Scoring were made using a pre-defıned checklist. Mann Whitney U test and Wilcoxon test were used to analyze non-normally distributed data. For the analysis of normally distributed data, Student t-test and Paired Samples t-test were used. Results demonstrated significant improvement in cricothyroidotomy performance with both types of video feedback. The improvement was significantly greater in the expert-assisted video feedback group. We think that simulation-based training is effective with self video feedback.
Abstract Background The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of two video feedback methods by comparing the improvement in performing cricothyroidotomy procedure following self video feedback (trainees review their performance by themselves) and expert-assisted video feedback (trainees review their performance while an emergency physician provides additional feedback). Methods This study was pretest-posttest and two-group designed research performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. After seeing an educational presentation and a best practice video, trainees were randomized into two groups; self video feedback group (SVFG) and expert-assisted video feedback group (EVFG). They performed the cricothyroidotomy before and after the feedback. The procedures were also recorded and scored by two emergency physicians. Results There was a statistically significant improvement between pre-feedback and post-feedback assessments in terms of scores received and time needed for the procedures in both SVFG and EVFG groups ( p < 0.05). Additionally, the post-feedback assessment scores were higher and time needed for the procedure was lower in the EVFG when compared with SVFG ( p < 0.05 for both). Conclusions Results demonstrated significant improvement in cricothyroidotomy performance with both types of video feedback method. Even though the improvement was better in the EVFG compared to the SVFG, the self video feedback may have value especially in situations where expert-assisted feedback is not possible.
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