RESUMEN
BACKGROUND: Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges. OBJECTIVE: To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination. SEARCH STRATEGY: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was January 2012. SELECTION CRITERIA: Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities. DATA COLLECTION AND ANALYSIS: The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes. MAIN RESULTS: In total, 11 272 articles were identified for screening, and 22 studies were eligible, enrolling 2036 trainees. In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0.86 (95% CI 0.52-1.19; P < 0.001). Four studies comparing simulation training for pelvic examination with no intervention had a large and significant benefit, with a pooled effect size of 1.18 (95% CI 0.40-1.96; P = 0.003). Among breast examination simulation studies, dynamic models providing feedback were associated with improved outcomes. In pelvic examination simulation studies, the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes. AUTHOR'S CONCLUSIONS: In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes. Enhanced feedback appears to improve learning.
Asunto(s)
Educación Médica/métodos , Tecnología Educacional , Ginecología/educación , Obstetricia/educación , Examen Físico , Competencia Clínica , Simulación por Computador , Femenino , Humanos , Maniquíes , Simulación de PacienteRESUMEN
Kytococcus shroeteri is a rare cause of prosthetic valve endocarditis. Here, we report what is believed to be the first case of K. schroeteri endocarditis to be treated successfully by daptomycin and review the published literature of K. schroeteri endocarditis. There are no published daptomycin susceptibility data for Kytococcus and additional work was carried out on six other isolates stored at the Laboratory of HealthCare Associated Infections (LHCAI), Health Protection Agency (HPA) Centre for Infections, Colindale, London.
Asunto(s)
Infecciones por Actinomycetales/diagnóstico , Actinomycetales/aislamiento & purificación , Antibacterianos/administración & dosificación , Daptomicina/administración & dosificación , Endocarditis Bacteriana/diagnóstico , Actinomycetales/clasificación , Actinomycetales/genética , Infecciones por Actinomycetales/tratamiento farmacológico , Técnicas Bacteriológicas/métodos , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Ecocardiografía Transesofágica , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Humanos , Londres , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify predictors of early and late outcome among 117 consecutive patients who underwent postinfarction ventricular septal defect (VSD) repair over a period of 12 years. METHODS: A retrospective analysis of clinical data was performed. Mean age was 65.5+/-7.8. There were 43 females. Full data were obtained in 110 patients. Of these, 76 patients presented with anterior and 34 with posterior VSD. Thirty-three patients were operated in cardiogenic shock. Mean time between myocardial infarction (MI) and VSD development was 5.6+/-7.8 days (median 4) and from VSD to surgery 9. 0+/-28.1 (median 2). Sixty-six patients had intraaortic balloon pump (IABP) inserted, and 15 were ventilated preoperatively. Logistic regression and Cox regression were used for multivariate analysis. RESULTS: Thirty days mortality was 37%. Among 110 patients, in whom complete analysis was possible, 38 died within 30 days (35%). Mortality in the posterior VSD group was 35% and in the anterior VSD group 34% (NS). In 44 patients (40%) a residual shunt was found on postoperative echocardiography. This required reoperation in 13 patients (four deaths). Cardiogenic shock prior to surgery adversely influenced early survival - odds ratio (OR) 5.7 (confidence interval (CI) 2.1-16.0) (P=0.0008). Deterioration of haemodynamic status in between admission and surgery was stronger predictor of mortality than shock on admission - OR 6.0 (CI 1.6-22.6) (P=0.008) vs. 3.1 (CI 1.0-9.3) (P=0.049). A longer time between MI and surgery favoured survival - OR 0.1 (CI 0.03-0.4) (P=0.002). The time period from the infarct to the septal rupture, but not from the rupture to surgery, appeared to be a significant predictor of survival - OR 0.2 (CI 0. 05-0.6) (P=0.008). Five years survival was 46+/-5%. Preoperative cardiogenic shock affected late survival - OR 2.7 (CI 1.5-4.9) (P=0. 001). Of 72 patients who survived 30 postoperative days, 12 (17%) were in New York Heart Association (NYHA) class III or IV and five (6.9%) in Canadian Cardiovascular Soceity (CCS) class III or IV at the last follow-up. CONCLUSIONS: Preoperative cardiogenic shock and early postinfarction septal rupture carry a grave prognosis. Achieving haemodynamic stability prior to surgery may be beneficial but prolonged attempts to improve patients' cardiovascular state are hazardous.