Change of collective orientation through an interprofessional training with medical students and student nurses depending on presence and professional group

BACKGROUND

Teamwork is an important success factors for patient treatment. The willingness of a healthcare provider to work in a team can be descripted with the construct of "Collective Orientation" (CO). The level of CO can be trained and is related to team performance. In this study, we investigated the effect of a simulator-based interprofessional training on the subject of patient fall in a hospital setting upon participations CO. To evaluate whether the course could be integrated into a longitudinal education concept, the participants were medical students and student nurses. Since effects of simulations can be influenced by the perceived reality, the results were measured as a function of Presence.

METHOD

In this observation study, 62 medical students and student nurses took part in six one-day interprofessional simulation trainings with the topic patient fall. The primary outcome was the mean difference between the CO measured immediately before (T1) and after the training (T2). The Presence of the participants was measured by questionnaire immediately after the course (T2).

RESULTS

Cronbach´s alpha for all scales and measurement points was higher than 0.69. CO increases over all professional groups from M = 3.42 (SD = 0.39) to M = 3.68 (SD = 0.54) significantly (p < .00; r = .5). Only the subscale "Dominance" in the professional group of the student nurses did not increase significantly. There was no correlation between Presence and the change in CO.

CONCLUSION

The questionnaires of CO and Presence can be applied to medical students and student nurses. The simulation course with the topic patient fall influences the CO and can be integrated in a longitudinal curriculum of teamwork training. The subscale "Dominance" of student nurses did not change. Preparatory learning units may increase the effects. The perceived reality of the scenario is not a main success factor.

[Catheterization of the subclavian vein and the risk of pneumothorax : Mechanical ventilation increases the risk of pneumothorax during infraclavicular landmark-guided subclavian vein puncture: a prospective randomized study]

BACKGROUND

Infraclavicular subclavian vein (SCV) catheterization is a standard procedure in anesthesia and intensive care. There is a lack of evidence on how mechanical ventilation during venipuncture of the SCV influences pneumothorax rates.

OBJECTIVE

Primary hypothesis: non-inferiority of continuing vs. discontinuing mechanical ventilation during infraclavicular puncture of the SCV with respect to the pneumothorax rate.

MATERIAL AND METHODS

This prospective, randomized and single-blinded study was approved by the local ethics committee. A total of 1021 eligible patients who underwent cranial neurosurgery in 2 different university hospitals were assessed between August 2014 and October 2017. Patients were randomly assigned to two groups directly before induction of anesthesia. Intervention groups for venipuncture of the SCV were mechanical ventilation: tidal volume 7 ml/kg ideal body weight, positive end expiratory pressure (PEEP) ideal body weight/10, n = 535, or apnea: manual/spontaneous, APL valve 0 mbar, n = 486. Patients and the physicians who assessed pneumothorax rates were blinded to the intervention group. Venipuncture was carried out by both inexperienced and experienced physicians.

RESULTS

The pneumothorax rate was significantly higher in the mechanical ventilation group (2.2% vs. 0.4%; p = 0.012) with an odds ratio (OR) of 5.63 (95% confidence interval, CI: 1.17-27.2; p = 0.031). A lower body mass index (BMI) was associated with a higher pneumothorax rate, OR 0.89 (95% CI: 0.70-0.96; p = 0.013).

CONCLUSION

In this study landmark-guided infraclavicular SCV catheterization was associated with a significantly higher rate of pneumothorax when venipuncture was performed during mechanical ventilation and not in apnea. If a short phase of apnea is justifiable in the patient, mechanical ventilation should be discontinued during the venipuncture procedure.

[Longitudinal study on the effectiveness+ of removable cast partial dentures]

A prospective longitudinal study of 33 middle-aged patients carried out over a period of four years and based on a standardized procedure provides evidence that, under the conditions examined, a hygienic design of removable cast partial dentures can be recommended as a structurepreserving approach. During this study a regular dental and oral hygiene regimen was maintained. An evaluation of the results according to tooth surfaces revealed typical highrisk areas which require particular attention in dental care. All in all, the results obtained in the course of time indicate that the patients' oral health status could be largely preserved.

[Prosthetic therapy for shortened dentitions]

The cast removable partial prosthesis is the choice for the management of unilaterally and bilaterally reduced tooth rows in practice. General constructional aspects concerning the shaping of the saddles and the utilization of the remaining teeth as abutments are treated together with problems of prevention.

[Prosthetic measures in the mixed dentition]

Prosthetic measures in the mixed dentition must allow for the actualities of this developmental phase. Traumatic or developmental injuries to enamel and dentine, accidental tooth loss and hypodontia or oligodontia are indications for prosthetic treatment in school children, at which orthodontic aspects should always be considered. The prosthetic approach is characterized by the respect to preventive aspects related to the further biomorphosis of the dentition. With reference to the different phases of mixed dentition, methodical suggestions are given in the form of tables.

[The influence of different feeding regimens on the capacity of lipolysis and ketogenesis during the neonatal period (author's transl)]

The capacity of lipolysis and ketogenesis as well as blood glucose homeostasis is studied in full-term newborn infants on different feeding formulas during the first days of life. Only with the aid of an oligosaccharide compound, carbohydrates can be administered in sufficient quantities, about 7 g/kg X 24 h, so that fat mobilization and ketogenesis are almost completely suppressed. This is not achieved by a regimen mimicing breast feeding in that no milk feeding takes place during the first day, nor by feeding maximal quantities of milk as soon as possible nor by administration of a mixed formula consisting of 10% glucose and milk. Though by early ingestion of large volumes of milk which without introducing tube feeding cannot be further enhanced total caloric intake almost equals the amount attained by the oligosaccharide formula the proportion of carbohydrates in respect to the latter only amounts to one third. In summing up the data reported herein demonstrate that the energy requirements of neonates cannot be supplied by usual dietary regimens, mainly due to the limitation of volume newborn infants can drink voluntarily. As a result of a deficiency in available carbohydrate lipolysis is stimulated in adipose tissue and ketosis arises. These are physiological adaptions resulting in increased availability of free fatty acids and ketone bodies which are easily utilized and thus satisfy the caloric requirements of the newborn infant.

[Prosthetic treatment of micrognathism following cleft lip and cleft palate surgery]

Delayed treatment of a patient having micrognathia after surgical correction of gnathopalatoschisis, using a bar joint between the telescopic devices on the remaining teeth, a maxillary cover denture and a supported mandibular model-cast prosthesis.