An analysis of 6 patients with periosteal osteosarcoma treated by the authors along with a review of 55 patients reported in the literature demonstrates that periosteal osteosarcoma is distinctly different from conventional osteosarcoma or periosteal chondrosarcoma. Periosteal osteosarcoma is a less aggressive tumor than conventional osteosarcoma. It is a relatively well‐differentiated chondroblastic osteosarcoma occurring on the surface of the long bones of the extremities. Three patients demonstrated frank medullary invasion of tumor, two grossly and one microsurgically. Patients treated with marginal resection had a 70% local recurrence rate. Patients receiving wide resection or primary amputation have survived longer with less recurrence of disease. Overall, 10 of 61 patients are dead with metastatic disease with a mean reported follow‐up of 6 years and 7 months. Adjunctive therapy has been of no demonstrable aid in terms of prolonging survival. Medullary extension of this tumor should not be used to exclude this diagnosis. The authors believe that the treatment of choice is wide resection without adjunctive chemotherapy.
Objectives: Genuine engagement during a clinical placement offers the students opportunity to link theory to practice and is recognised as a valuable addition to their education curriculum. However, clinical placements can place both students and patients at risk. Consolidation of theory into practice is hampered as there is rarely adequate time or ability for feedback and debriefing. The unpredictable nature of healthcare means students are not guaranteed experiences which will allow them to consolidate theory into practice, and they can become peripheral observers, instead of active participants. Low acuity patients can deteriorate quickly, which students may not be able to detect, or respond to, in an appropriate or timely manner. This program was designed to provide students with a standardised set of cases prior to placement to ensure basic clinical skills were in place and that appropriate responses to deteriorating patients were understood and implemented. The program was particularly innovative in the use of automated feedback to improve inter-rater reliability and to identify individual and group learning needs to the nursing educators. Due to limited resources, the scenarios needed to be able to process large student numbers in a short time with minimal educator resources.Description: The program was developed following a needs analysis by the hospital's education team. Nursing educators were surveyed to identify previous skill gaps that had occurred with nursing students, where the patient or the student was placed at risk. This data was compared with adverse event registries and coroner's reports. Three short, low cost scenarios were developed based on findings. Both expected and unexpected actions were programmed into the mobile device used to grade the student's performance. At the completion of each simulation an automatically generated, personalised report was given to each student along with their verbal debrief. Once developed, this method significantly increased the capacity of the simulations and reduced the need for experienced educators. These reports identified areas of clinical strength and weakness among the student cohort, and also provided administrators with evidence of compliance to hospital accreditation standards. A mixed methods approach was used to evaluate the program. Students and nurse educators completed surveys and focus groups to rate the quality and utility of the program. Conclusion:The use of adverse event data, to generate the simulations, created situations that the students and educators considered to be relevant, realistic and worthwhile. Using pre-programmed scenarios improved inter-rater reliability and allowed the use of staff previously unfamiliar with simulation to support the program. Pre-populated feedback provided students with a standardised, objective and permanent record of performance that placed no demand on educational staff once developed. The program revealed group learning needs that might otherwise have been missed or mistaken for individual learning...
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