This paper describes a process undertaken at the University of Alaska Fairbanks to select a model for teaching freshman engineering design. The project identified and characterized methods in use for teaching freshman design, and selected method(s) appropriate for UAF with general recommendations for implementation. Background research included a needs and information survey of freshmen and senior engineers, and research on methods currently used to teach design at ABET accredited colleges and universities. Eight methods for teaching design to freshman engineering students were identified. A Weighted Factor Scoring Model was used to determine which methods of teaching design were most applicable to UAF. A reverse engineering model was selected and proposed for the new freshman engineering design course. The methodology, results, and other considerations are discussed. B. Perspective of the StudentsA two page, thirty-eight question survey was developed in order to gain a better understanding about the UAF freshman and senior engineering students in the CE, EE, and ME programs, and specifically, information that might be useful in developing a new
A stoma has a substantial impact on patient quality of life and within the enhanced recovery protocol; all efforts are made to improve patient care, reduce complications and shorten hospital stay after colorectal resection. In this article, Julie Burton, Joanna Allison, Neil Smart and Nader Francis discuss the literature surrounding the impact of stoma formation on enhanced recovery after elective colorectal resections. The factors that influence this are discussed including type of surgery, type and site of stoma, early complications and preoperative stoma training. Practical stoma education, optimum communication and patient motivation are outlined as essential components of pre-operative care. Strategies to reduce stress after early discharge are also addressed, alongside the impact of early stoma complications on length of stay. Optimum support from the stoma care nurse specialist both in secondary care and the community are also explored.
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Background Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. Methods A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far–near–near–far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon’s standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. Results Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). Conclusion The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. Registration number ISRCTN25616490 (http://www.controlled-trials.com).
Objectives & BackgroundThere has been an increasing use of massive haemorrhage protocols (MHP) within our trust. A number of clinical incidents were noted around roles/responsibilities when MHPs were run. Design failures (latent errors) were felt to contribute to these. Most MHPs are untested and are reliant on clear protocols, good communication and efficient team work. We proposed that running drills of our MHP in the ED setting would allow us to identify the latent errors and human factors that exist in our MHP then addressing these.MethodsWe proposed a 2 stage process where initially we tested functionality then identified and changed aspects of the system.FunctionalityWe ran 5 in-situ, real time MHP simulations involving the relevant members of the MDT in the ED. The 20 minute scenarios were followed by a structured human factors debrief. This allowed us to establish latent errors that were affecting the MHP. Results were then collated and codified from the sessions to allow planning of teaching for ED and non-ED staff.RedesignFollowing this a card redesign was identified as being necessary. We used the principles of negative space, contrast, proximity and the pictorial superiority effect. A cluster randomised recall trial was then conducted at an F2 teaching session (66 participants), with participants blinded to the other version of the cards. A trauma video was shown (thoracotomy) and recall measured after this. Data analysed by an author blinded to both the study design and the data collection. GAfREC permission given by R+D.ResultsHF/Ergonomics phase1. Difficulty identifying team members/roles2. Communication difficulties-same task being undertaken by multiple staff members3. Notes/ID labels not given to trauma team leader (TTL). TTL felt to be unapproachable4. Porters not feeling able to identify themselves5. Action cards and protocol not used-text heavy6. Staff not realising action cards were double sided7. Blood forms unavailable8. Poor prioritisation/labelling of the crossmatch sample9. Pre-arrival preparation steps being omittedCard redesign phase18 people recalled all the important information – all used the new cards. 0 people in the old card group recalled all the information. 66 of the f2s (100%) preferred new design of card.ConclusionHF principles helped identify areas for improvement. Utilising design principles appears to have had significant impact on the effectiveness of the cards.
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