Despite advances in detection and treatment, acute traumatic aortic injury (ATAI) is associated with high rates of morbidity and mortality. Both physical and hemodynamic forces have been postulated as mechanisms of aortic injury during a traumatic event. For patients who survive the initial injury, rapid detection is critical for diagnosis and procedural planning, which requires a thorough knowledge of both its clinical presentation and the available diagnostic imaging modalities. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can each have a role in the diagnosis of ATAI.After stabilization of the patient, the management of ATAI is guided by the severity of injury. Appropriately selected patients with low grade injuries may be managed non-operatively. When treatment is required, there are both open surgical and endovascular options. In current practice, endovascular approaches with stentgraft placement are preferred due to their high clinical success and low rates of complications. Complications from endograft placement can include: endoleak, endograft collapse, infection, endograft failure, and endograft migration. Open surgical repair is now reserved for patients with unfavorable anatomy for endovascular therapies. This review provides a comprehensive overview of ATAI including its epidemiology and demographics, mechanisms of injury, clinical and radiographic diagnosis, treatment options, and posttherapeutic follow-up.
Medical teachers and practising doctors were surveyed by questionnaire and given pre-and post-tests to determine the efficiency and effectiveness of Practical Reviews in Cancer Management, a cassette tape programme of continuing medical education (CME). Doctors indicated a high degree of satisfaction with this approach; in particular the idea of keeping abreast of the current literature while commuting in their cars was appealing.The programme's effectiveness was measured by pre-and post-tests, and the data were analysed by the non-directional f-test for dependent groups.These tests indicated a significant ( P < 0.001) increase in knowledge from the pre-to post-tests.
Clinical algorithms have been used successfully in a variety of health care settings to assist health care professionals in the diagnosis and management of medical problems. In addition to their clinical applications, algorithms also serve as an instructional resource by themselves and when used in conjunction with other educational methodologies. A recommended algorithm development process is described for cancer educators who wish to take advantage of the unique contribution clinical algorithms can offer for their educational programs. Algorithm design conventions are reviewed and specific writing suggestions are offered for the guidance of educators who want to design their own clinical algorithms. Objections to clinical algorithms can often be attributed to a misunderstanding of their proper role, which is to facilitate, not dictate, the decision process and guide the application of management logic. Clinical algorithms are a valuable instructional resource that can be used in a wide range of educational settings from self-instruction units to the design of lecture presentations.
Primary care physicians were trained on three rheumatology topics to assess the effectiveness of an educational strategy for continuing medical education. Algorithm training was shown to be at least as effective as that based on standard prose monographs. Both training groups improved their knowledge of patient management skills but there were no statistically significant differences between groups in the amount learned. When algorithms were used to design text materials, the designed texts required less study time than did the annotated clinical algorithms alone. That difference was significant for the shoulder pain materials (P < 0.05) but not for the osteoporosis materials. The ratio of knowledge gained to study time was significantly higher for the algorithm group on the low back pain topic (P < 0.05) but not for the other topics. Taped interview problems tests were studied as a method for assessing patient management skills related to problem-specific indicator conditions and were found to produce interrater reliability greater than 0.80 on five of the six tests.Continuing Medical Education (CME) is a critical link in the process of transferring the knowledge gained from arthritis research into the clinic environment where it can benefit patients. Improvements in patient care and outcomes frequently depend upon the education of health care providers on improved techniques, medications, and treatment strategies. This paper presents data obtained from a study sponsored by the National Fund for Medical Education. That study sought to assess the effectiveness of clinical algorithms (i.e., decision-making flow charts) as an instructional methodology in a CME environment for primary care physicians. The specific research question addressed was: "Do practitioners learn more effectively and efficiently from clinical algorithms than from standard prose texts?" In connection with the CME training experiments conducted with three annotated clinical algorithms covering rheumatology topics, this study also provided the opportunity to examine the reliability of a taped interview problems (TIP) test of patient management skills and the impact of clinical algorithms in helping to construct educational materials.
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