Treatment of lower limb chronic venous disease has progressed exponentially over recent decades. The advances achieved have made it possible to develop a proposal for a systematized intravenous laser ...ablation technique — assisted total thermal ablation (ATTA). The technique constitutes a standardized method for management of axial or tributary veins that are varicosed or esthetically unappealing, whether in the lower limbs or other areas, that can be performed on an outpatient or day-hospital basis. This article describes the processes for preoperative preparation and detailed marking, the materials needed, venous access, anesthesia, calculation of power and energy, the ablation technique itself, follow-up, and adverse events. The ATTA technique is proposed as a tool for treatment of chronic venous disease and of esthetically unappealing veins, suggesting possible extension of the applications for lasers beyond trunk veins to any vein that can be punctured.
For centuries, medicine aimed to treat abnormalities. But today normality itself is open to medical modification. Equipped with a new molecular understanding of bodies and minds, and new techniques ...for manipulating basic life processes at the level of molecules, cells, and genes, medicine now seeks to manage human vital processes. The Politics of Life Itself offers a much-needed examination of recent developments in the life sciences and biomedicine that have led to the widespread politicization of medicine, human life, and biotechnology. Avoiding the hype of popular science and the pessimism of most social science, Nikolas Rose analyzes contemporary molecular biopolitics, examining developments in genomics, neuroscience, pharmacology, and psychopharmacology and the ways they have affected racial politics, crime control, and psychiatry. Rose analyzes the transformation of biomedicine from the practice of healing to the government of life; the new emphasis on treating disease susceptibilities rather than disease; the shift in our understanding of the patient; the emergence of new forms of medical activism; the rise of biocapital; and the mutations in biopower. He concludes that these developments have profound consequences for who we think we are, and who we want to be.
This innovation is intended to instruct medical students, residents of all levels, and mid-level practitioners.
Pelvic examinations are essential components to clinical practice but are challenging ...to teach, learn, and practice on live patients secondary to patient comfort because this is an invasive procedure.1 Resident physicians and medical students traditionally learn these methods through observation while actively working in their department or clinics.2 Simulation models can improve a provider's competency and confidence performing pelvic examinations which improve patient comfort and exam accuracy.3 One barrier to simulation training is the cost of the pelvic simulator models. A basic pelvic exam simulator costs $365.4 The cost is high, therefore limiting the availability of a simulation model accessible to residency programs across the country. This barrier to pelvic models was overcome by developing a homemade alternative for cervical examination and collection of screening swabs. The model created can be easily manufactured by students, residents, and faculty alike for less than $20 and approximately two hours of manufacturing time. A literature review was conducted to find similar products and other production methods for a pelvic examination model. No comparable models were found.This is a guide to utilizing supplies from a local dollar store combined with home recycling products and a few common crafting tools to create a realistic pelvic examination model.
After utilizing this pelvic examination model, the learner will be able to: 1) demonstrate ability to perform a pelvic examination comfortably and safely, 2) demonstrate ability to obtain a cervical swab on female patients, and 3) show proficient understanding of female anatomy.
The pelvic exam model is utilized to effectively teach proper technique for pelvic examinations. This model can be utilized to teach medical students, incoming residents, and new mid-levels. Senior residents, experienced mid-levels, or attendings who are experienced in completing pelvic examinations can easily utilize this model to teach proper technique.
The data for this study was collected from a single graduate medical education program in Detroit, Michigan. This was designed as a single blind survey where the reviewer's identities were kept anonymous from the data collectors. Surveys were collected from attendings, residents, mid-level providers, and medical students across specialties of emergency medicine, family medicine, obstetrics and gynecology.
A total of 77 individuals tested the homemade model and compared it to a pelvic exam on a live patient as well as a commercial pelvic exam model. Survey results showed the low-cost homemade model was just as effective as a commercially manufactured model, with some respondents saying the DIY model was more effective and more realistic. Comparing the commercial models to the homemade model, 54 of the 77 participants had experience with a commercial model. In the survey when compared to a commercial model, 57% of the participants felt the examination was the same, and 31% indicated the homemade model felt more realistic.
Overall, the homemade cost-effective model is comparable if not more realistic to more expensive commercial models. The main take away of this innovation, to remember it is possible to create cost-effective models for realistic, educational learning. This model has one limitation because it is not suitable for a bimanual examination, but it can be expanded to allow for bimanual examination.
Pelvic examination, cervical examination, creative simulation models.
•The concept ‘creative destruction’ is applied to study policy mixes for transitions.•The novel analytical framework combines niche support with regime destabilisation.•Destabilising policies imply ...replacement of rules, actors and technology support.•Low energy policy mixes in Finland and the UK have few destabilising policies.•The positive accumulation of creative and destructive policies could act as a motor.
Recently, there has been an increasing interest in policy mixes in innovation studies. While it has long been acknowledged that the stimulation of innovation and technological change involves different types of policy instruments, how such instruments form policy mixes has only recently become of interest. We argue that an area in which policy mixes are particularly important is the field of sustainability transitions. Transitions imply not only the development of disruptive innovations but also of policies aiming for wider change in socio-technical systems. We propose that ideally policy mixes for transitions include elements of ‘creative destruction’, involving both policies aiming for the ‘creation’ of new and for ‘destabilising’ the old. We develop a novel analytical framework including the two policy mix dimensions (‘creation’ and ‘destruction’) by broadening the technological innovation system functions approach, and specifically by expanding the concept of ‘motors of innovation’ to ‘motors of creative destruction’. We test this framework by analysing ‘low energy’ policy mixes in Finland and the UK. We find that both countries have diverse policy mixes to support energy efficiency and reduce energy demand with instruments to cover all functions on the creation side. Despite the demonstrated need for such policies, unsurprisingly, destabilising functions are addressed by fewer policies, but there are empirical examples of such policies in both countries. The concept of ‘motors of creative destruction’ is introduced to expand innovation and technology policy debates to go beyond policy mixes consisting of technology push and demand pull instruments, and to consider a wider range of policy instruments combined in a suitable mix which may contribute to sustainability transitions.
AudienceThis suite of borescope laryngoscopes is designed to instruct emergency medicine residents and sub-interns in video-assisted airway management. BackgroundSkillful and confident airway ...management is one of the markers of a strong emergency medicine physician.1 Video-assisted airway management is a necessary skill, particularly in the setting of difficult airways and cervical spine immobilization.2,3 However, the idea of learning airway management "by doing" is high-risk and mistakes can have devastating implications on patient outcomes. Fortunately, high-fidelity medical simulation tools have been developed to address this dilemma, allowing a safe environment for providers to practice their airway management skills.4,5 These tools, while undeniably useful, are limited in their scope; they are often designed for clinical rather than educational use, and are proprietary and expensive.6,7Video laryngoscopes approved for patient use are difficult to implement widely in educational settings due to cost or because they cannot be removed from a designated area. Clinical video laryngoscopy suites typically cost 2,000 - 6,000 US dollars. Additionally, the video images can only be viewed on a local small screen rather than a television or projector. This means that the number of learners is limited by space around the small laryngoscope screen. These cost and space barriers may be especially pronounced in low resource or non-traditional learning environments. Educational ObjectivesUsing an anatomically accurate airway simulator, by the end of a 20-30-minute instructional session, learners should be able to: 1) Understand proper positioning and use the video laryngoscope with dexterity, 2) identify airway landmarks via the video screen, and 3) demonstrate ability to intubate a simulated airway. Educational MethodsWe developed a low-cost borescope laryngoscope for airway simulation training. Using this device, learners should be able to identify airway landmarks and successfully intubate a simulated airway. The borescope laryngoscope, a novel device which employs the camera-end of a video borescope and a single-use VL blade, was used by learners during high-fidelity airway simulation. Learners were residents or medical students undergoing airway training in case-based simulation, or in airway-management procedure stations. Research MethodsThe borescope laryngoscopes were used during dedicated airway training in place of their medical device counterparts. During case-based simulation sessions involving airway management, 32 residents and 20 medical students used the borescope laryngoscope. During dedicated airway management procedure stations, 12 medical students used the borescope laryngoscope. Learners were instructed to perform endotracheal intubation and fully visualize critical structures before passing the tube. Successful intubation was defined as the ability to pass the tube independently or with the help of the instructor. ResultsThe borescope laryngoscope proved effective at video visualization of critical structures. Compared to official medical equipment, the VL borescope similarly allowed for visualization of a Cormack-Lehane Grade 1 view. Learners were able to visualize the airway anatomy and successfully pass the ET tube on each pass either independently or with the help of the instructor. DiscussionThe development of this airway-training tool was effective and less expensive than medical grade versions. Our group of learners successfully visualized essential anatomy and passed an endotracheal tube (ED tube) through the vocal cords. The borescope laryngoscope offers a comparable user experience at a much lower cost. The devices also allowed instructors to teach video laryngoscopy without depending on clinical equipment. Widespread use may allow for expansion of airway simulation training while maintaining a high-fidelity learner experience. TopicsVideo laryngoscopy, borescope, improvised equipment, airway training.
AudienceThis procedure training model is designed for all levels of emergency medicine residents. BackgroundPericardiocentesis is a relatively uncommon but potentially life-saving procedure within ...the scope of Emergency Medicine practice. As such, the Accreditation Council for Graduate Medical Education (ACGME) designates its competency as a requirement within emergency medicine residency programs. Because of its relative rarity, simulation-based training is often utilized to fill the gaps in clinical experience during emergency medicine residency training. There have been several models of pericardiocentesis training, including gel-based models that can be purchased or constructed,1-3 non-gel models,4 and cadaveric models.5 In this paper, we describe the fabrication of a high-fidelity cadaveric model and report emergency medicine resident experience with this model. Training programs can use this model to increase trainee competence and confidence with this high-acuity, low-frequency procedure. Educational ObjectivesBy the end of this session, residents will gain increased procedural competence and confidence with pericardiocentesis. Residents will be able to identify necessary supplies for the procedure, identify relevant surface anatomy and ultrasound views, and successfully aspirate fluid from model effusion. Educational MethodsWe created a pericardial effusion in a soft prep cadaver by placing a catheter into the pericardial sac and then infusing normal saline via intravenous fluid tubing. Learners were then able to practice aspiration of pericardial fluid via landmark and ultrasound-guided approaches under observation by facilitators able to offer real-time feedback. Research MethodsLearners were asked to complete a survey assessing pre-intervention and post-intervention subjective confidence in their ability to perform pericardiocentesis and were asked for qualitative feedback on the experience of using the training model. ResultsAll residents were able to successfully visualize the pericardial effusion and perform needle aspiration via parasternal and subxiphoid approaches under dynamic ultrasound guidance, allowing needle visualization. All residents reported a subjective increase in procedural confidence and competence after practicing with this training model. DiscussionOverall, the primary benefit of this training model cited by emergency medicine residents was that it closely approximates reality. This model is re-usable, relatively durable, and reproducible. Emergency medicine residencies associated with academic medical centers that already utilize cadavers for education may relatively easily incorporate this training model into their procedure training curriculum. TopicsPericardiocentesis, simulation, task trainer.
Vascular malformations can be treated using sclerotherapy agents like alcohol, polidocanol, or sodium tetradecyl sulfate foam and embolization treatments. These endovascular treatments may cause ...severe complications as pulmonary embolism and thrombosis. 980-nm diode lasers (DLs) are common devices used by many specialties as plastic surgeons, dermatologists, and vascular surgeons. Laser energy is excellently absorbed in water and hemoglobin, which makes it ideal for adipose tissue and deep lesions. We treated our patient using a DL. Our surgical approach allowed total excision of the arteriovenous malformation (AVM), which decreased the size of the tumor allowing a smaller incision and eased the dissection plane. We believe that lasers will be used more frequently on AVM treatments.
Intralesional therapy is a common treatment for keloid. However, because of some follicular openings and comedones on the surface of the keloid on the hairy chest and acne keloidalis, there is a risk ...of drug leakage, and sometimes ejection of drugs like a jet spray leads to therapy being ineffective. The authors describe a novel and effective method for preventing drug loss from follicular openings during intralesional therapy. To prevent drug loss during intralesional injection, cyanoacrylate glue is applied to the follicular and comedone openings on the keloid's surface.
Applying Innovation O′Sullivan, David; Dooley, Lawrence
2008, 2009, 2008-06-23
eBook
A step-by-step approach to applying high-impact innovation principles in any organization Innovation is an important force in creating and sustaining organizational growth. Effective innovation can ...mean the difference between leading with a particular product, process, or service--and simply following the pack. Innovation transforms mediocre companies into world leaders and ordinary organizations into stimulating environments for employees. Applying Innovation combines the key ingredients from areas including innovation management, strategic planning, performance measurement, creativity, project portfolio management, performance appraisal, knowledge management, and teams to offer an easily applied recipe for enterprise growth. Authors David O′Sullivan and Lawrence Dooley map out the main concepts of the innovation process into a clear, understandable framework--the innovation funnel. Unlike other texts for this course, Applying Innovation goes beyond methodologies and checklists to offer an invaluable step-by-step approach to actually applying high-impact innovation in any organization using a knowledge management systems, whether for a boutique firm or one comprised of thousands of individuals. Key Features: Adopts a practical approach to overseeing innovation that focuses on useful tools and techniques rather than on theory and methodologies Offers student activities within the text for immediate application of key concepts, reinforcing retention and comprehension Teaches students to build and apply effective innovation management systems for any organization successfully, regardless of the firm′s size or structure Intended Audience: Applying Innovation is designed for undergraduate and graduate courses such as Innovation Management, Project Management, Strategic Planning, and Performance Management in fields of business, science,
and engineering. This book appeals to instructors who want to reduce the "chalk and talk" and increase the hands-on practicality of their courses in innovation management.
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