Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the g... more Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the gluteus maximus and gluteus medius muscles, respectively. However, little research has confirmed the reliability of these sites for the presence and thickness of the target and other muscles, and subcutaneous fat. This study characterised and compared these at the V-method and G-method ventrogluteal sites and dorsogluteal site (n=60). Gluteus maximus, medius and minimus were identified at each site, plus tensor fascia latae at ventrogluteal sites. Gluteus maximus and subcutaneous fat were significantly thicker and gluteus minimus significantly thinner at the dorsogluteal site than both ventrogluteal sites. Gluteus medius was the thickest muscle at each injection site, and thicker at the G-method than the V-method ventrogluteal site. Therefore, the dorsogluteal site reliably targets gluteus maximus, and the G-method ventrogluteal site was more reliable than the V-method ventrogluteal site to target gluteus medius in terms of presence and thickness.
International Journal of Mental Health Nursing, Jul 28, 2017
The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular in... more The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular injections; however, it remains infrequently utilized due to nurses' lack of confidence in site identification. The more recent G (geometric) method of ventrogluteal site identification is less subjective and likely more reliable than the V method for successful intramuscular injection outcomes. Knowledge of muscle and subcutaneous fat thicknesses, and the influence of sex and anthropometry on theoretical injection outcome, is necessary to support evidence-based use of the ventrogluteal site. In the presents study, we compared the V and G methods for injection site subcutaneous fat, muscle, and total tissue thicknesses, and theoretical injection outcome (bone injury, intramuscular or subcutaneous), and determined anthropometric predictors of injection outcome. Subcutaneous fat and muscle thicknesses were measured via ultrasound, bilaterally at V and G method sites (28 males, 32 females). Muscle and total tissue were significantly thicker, and successful intramuscular injection significantly more likely, using the G versus V method (75% versus 57%). Females had significantly thicker subcutaneous fat than males at both sites. Even using the G method, 92% of males but only 59% of females, would have a successful intramuscular injection, with remaining females at risk of bone injury (16%) or subcutaneous injection (25%). The G method site is more reliable for successful intramuscular injection, with less risk of bone injury than the V method site. Appropriate needle-length selection is essential for females with a body mass index (BMI) <23 kg m À2 and weight <60 kg (to avoid bone injury), and BMI >30 kg m À2 and hip >90 cm (to avoid subcutaneous injection).
Background: More than fifty years ago, Jerome Bruner introduced the spiral curriculum based on co... more Background: More than fifty years ago, Jerome Bruner introduced the spiral curriculum based on constructivist ideas. Most fields of education adopted this concept which promises to enable the learner to develop their ability to transfer thinking processes from one context to another-also an essential skill for a medical doctor. Aim: By implementing the spiral curriculum model throughout our course, we aim to not only accelerate our students' learning, we also seek to better prepare them to master situations that arise infrequently or urgently, such as the need for life support skills. Method: Based on the our MBBS entry requirement "Possession of a First Aid Certificate ", our clinical skills teaching revisits "Basic Life Support (BLS)" on several occasions throughout the four year degree, building cumulatively on already learnt content. We guide the students to acquire new psychomotor skills at the same time as applying already learnt concepts and facilitating their ongoing learning through inquiry. Equipped with these skills students participate then in our graded submersive, high-fidelity manikin-based simulation program with a focus on BLS and Advanced Life Support (ALS) scenarios. Results: Evaluation comments such as; "CPR is vital for medical training" , "Great revision of BLS, Automated External Defibrillation (AED) and bagging" or "An excellent activity, reinforced lots of physiology and pharmacology while also refreshing BLS/ALS" demonstrate the acceptance of the spiral teaching approach by the students and validates the effort and dedication of our staff.
contributed to conception and design of the study. Theresa Larkin was responsible for data analys... more contributed to conception and design of the study. Theresa Larkin was responsible for data analysis and interpretation, and drafting the article. All authors contributed to data acquisition, and critical revision and final approval of the manuscript.
Background: The dorsogluteal and ventrogluteal intramuscular injection sites both have their use ... more Background: The dorsogluteal and ventrogluteal intramuscular injection sites both have their use in clinical practice; however, it has not been established in whom one or the other should be preferentially targeted or avoided. There is a need for an evidence-based approach towards site selection for a successful intramuscular injection outcome and to avoid unwanted injection outcomes of inadvertent subcutaneous injection or bone contact. Injection outcome is dependent on injection site subcutaneous fat thickness and muscle thickness; these are likely influenced by gender and anthropometry. Objectives: To determine whether subcutaneous fat, muscle, and total tissue thicknesses differ between the dorsogluteal and ventrogluteal sites, and whether theoretical injection outcome (intramuscular, subcutaneous, or bone contact) can be predicted by demographic and anthropometric data and described by an algorithm. Design: Cross-sectional study design. Settings: University in Australia. Participants: 145 volunteers (57% female) of at least 18 years of age recruited through the university community. Methods: Anthropometric data was collected and subcutaneous fat and muscle thicknesses were quantified by ultrasonography. Anthropometric differences between theoretical injection outcome groups (bone contact versus intramuscular versus subcutaneous at the ventrogluteal and dorsogluteal sites) was determined for each gender (ANOVA). Multiple regression analysis was conducted to determine the influence of demographic and anthropometric data on theoretical intramuscular injection outcome. An algorithm to guide site selection was developed for each gender, based on the anthropometric measures that best discriminated between injection outcomes. Results: Subcutaneous fat, muscle and total tissue were significantly thicker at the dorsogluteal site than the ventrogluteal site, and subcutaneous fat was significantly thicker in females than males at both sites (all p < 0.001); there was no gender difference for muscle or total tissue thickness at either site. Female gender, and waist and hip circumference were significant predictors of subcutaneous fat thickness at both sites; male gender was a significant predictor of dorsogluteal site muscle thickness (all p < 0.05). In the algorithm developed for site selection based on theoretical injection outcome, the best discriminators were: weight, BMI and waist circumference for females, and weight and distance between the iliac tubercle and anterior superior iliac spine for males. Conclusions: The algorithm describes when each of the ventrogluteal and dorsogluteal sites is appropriate or should be avoided, based on easily obtained anthropometric data. This has direct relevance in clinical practice in evidence-based site selection for gluteal intramuscular injections for optimal medication and health outcomes.
Morphology and anatomical relations of iliac and femoral bony landmarks, Morphology and anatomica... more Morphology and anatomical relations of iliac and femoral bony landmarks, Morphology and anatomical relations of iliac and femoral bony landmarks, gluteal muscles and the sciatic nerve: Sex differences and clinical gluteal muscles and the sciatic nerve: Sex differences and clinical implications implications
At the first meeting, Council members discussed a set of guidelines designed to focus the council... more At the first meeting, Council members discussed a set of guidelines designed to focus the council's efforts. The resulting document is excerpted below: The Council shall study and report upon the forest certification systems being used in Maine. In particular, the Council is charged with answering the following questions, though should not refrain from addressing such issues members feel are important: * http://madison.merid.org/comparison/FSC_SFI_Comp_Analysis-Exec_Summary.pdf As discussed in the following sections, there are many similarities and some differences between the two programs. Because landowners may exceed the minimum requirements of either program, differences that loom large on paper may be less apparent on the ground. These aspects as they relate to the Council's vision of a credible audit system are discussed below.
Laboratory classes are congested with factual information and demonstration (“show and tell”). St... more Laboratory classes are congested with factual information and demonstration (“show and tell”). Students, however, rarely have enough time to explore equipment and to acquire technical problem solving skills. The idea to develop a laboratory session that differed from the ...
In this paper we present a Model-Based Testing approach with which we generate tests from an abst... more In this paper we present a Model-Based Testing approach with which we generate tests from an abstraction of a source behavioural model. We show a new algorithm that computes the abstraction as an under-approximation of the source model. Our first contribution is to combine two previous approaches proposed by Ball and Pasareanu et al. to compute May, Must+ and Must-abstract transition relations. Proof techniques are used to compute these transition relations. The tests obtained by covering the abstract transitions have to be instantiated from the source model. So, following Pasareanu et al., our algorithm additionally computes a concrete transition relation: the tests obtained as sequences of concrete transitions need not be instantiated from the source model. Another contribution is to propose a choice of relevant parameters and heuristics to pilot the tests computation. We experiment our approach and compare it with a previous approach of ours to compute tests from an abstraction that over-approximates the source model.
Training simulated patients effectively is vital for the success of the patient volunteer program... more Training simulated patients effectively is vital for the success of the patient volunteer programme in the Graduate School of Medicine at the University of Wollongong. Globally, simulated patients play an essential role in contemporary medical education. Yet, there is a significant gap in the research literature regarding their training and the impact of their feedback on student learning. In 2010, our 2nd and 3rd year medical students replicated realistic interview situations as part of our simulated patient training. This intervention allowed patient volunteers to give feedback but also to receive feedback on their feedback giving skills from students. During these interactions, a strong sense of reciprocal teaching and learning between the incumbent simulated patients and the participating students emerged. Based on these observations, we conducted focus group interviews with both parties. Participants reported an enriched educational experience and better understanding of each other's role in the teaching relationship. Volunteers commented that the approach has given them a better comprehension of the expectations placed upon them by students. Students appreciated the opportunity to support volunteers in what they see as a vital aspect of their medical training.
Why do medical students volunteer to train simulated patients? A Why do medical students voluntee... more Why do medical students volunteer to train simulated patients? A Why do medical students volunteer to train simulated patients? A qualitative evaluation of motivations and incentives qualitative evaluation of motivations and incentives
One of the remaining challenges in simulation-based medical education (SBME) is to show that it h... more One of the remaining challenges in simulation-based medical education (SBME) is to show that it has a positive impact on clinical outcome (1). We report an investigation of simulation teaching in medical students using self-reported measures of change in practice as a surrogate ...
Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the g... more Intramuscular injections given at the dorsogluteal and ventrogluteal sites are intended for the gluteus maximus and gluteus medius muscles, respectively. However, little research has confirmed the reliability of these sites for the presence and thickness of the target and other muscles, and subcutaneous fat. This study characterised and compared these at the V-method and G-method ventrogluteal sites and dorsogluteal site (n=60). Gluteus maximus, medius and minimus were identified at each site, plus tensor fascia latae at ventrogluteal sites. Gluteus maximus and subcutaneous fat were significantly thicker and gluteus minimus significantly thinner at the dorsogluteal site than both ventrogluteal sites. Gluteus medius was the thickest muscle at each injection site, and thicker at the G-method than the V-method ventrogluteal site. Therefore, the dorsogluteal site reliably targets gluteus maximus, and the G-method ventrogluteal site was more reliable than the V-method ventrogluteal site to target gluteus medius in terms of presence and thickness.
International Journal of Mental Health Nursing, Jul 28, 2017
The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular in... more The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular injections; however, it remains infrequently utilized due to nurses' lack of confidence in site identification. The more recent G (geometric) method of ventrogluteal site identification is less subjective and likely more reliable than the V method for successful intramuscular injection outcomes. Knowledge of muscle and subcutaneous fat thicknesses, and the influence of sex and anthropometry on theoretical injection outcome, is necessary to support evidence-based use of the ventrogluteal site. In the presents study, we compared the V and G methods for injection site subcutaneous fat, muscle, and total tissue thicknesses, and theoretical injection outcome (bone injury, intramuscular or subcutaneous), and determined anthropometric predictors of injection outcome. Subcutaneous fat and muscle thicknesses were measured via ultrasound, bilaterally at V and G method sites (28 males, 32 females). Muscle and total tissue were significantly thicker, and successful intramuscular injection significantly more likely, using the G versus V method (75% versus 57%). Females had significantly thicker subcutaneous fat than males at both sites. Even using the G method, 92% of males but only 59% of females, would have a successful intramuscular injection, with remaining females at risk of bone injury (16%) or subcutaneous injection (25%). The G method site is more reliable for successful intramuscular injection, with less risk of bone injury than the V method site. Appropriate needle-length selection is essential for females with a body mass index (BMI) <23 kg m À2 and weight <60 kg (to avoid bone injury), and BMI >30 kg m À2 and hip >90 cm (to avoid subcutaneous injection).
Background: More than fifty years ago, Jerome Bruner introduced the spiral curriculum based on co... more Background: More than fifty years ago, Jerome Bruner introduced the spiral curriculum based on constructivist ideas. Most fields of education adopted this concept which promises to enable the learner to develop their ability to transfer thinking processes from one context to another-also an essential skill for a medical doctor. Aim: By implementing the spiral curriculum model throughout our course, we aim to not only accelerate our students' learning, we also seek to better prepare them to master situations that arise infrequently or urgently, such as the need for life support skills. Method: Based on the our MBBS entry requirement "Possession of a First Aid Certificate ", our clinical skills teaching revisits "Basic Life Support (BLS)" on several occasions throughout the four year degree, building cumulatively on already learnt content. We guide the students to acquire new psychomotor skills at the same time as applying already learnt concepts and facilitating their ongoing learning through inquiry. Equipped with these skills students participate then in our graded submersive, high-fidelity manikin-based simulation program with a focus on BLS and Advanced Life Support (ALS) scenarios. Results: Evaluation comments such as; "CPR is vital for medical training" , "Great revision of BLS, Automated External Defibrillation (AED) and bagging" or "An excellent activity, reinforced lots of physiology and pharmacology while also refreshing BLS/ALS" demonstrate the acceptance of the spiral teaching approach by the students and validates the effort and dedication of our staff.
contributed to conception and design of the study. Theresa Larkin was responsible for data analys... more contributed to conception and design of the study. Theresa Larkin was responsible for data analysis and interpretation, and drafting the article. All authors contributed to data acquisition, and critical revision and final approval of the manuscript.
Background: The dorsogluteal and ventrogluteal intramuscular injection sites both have their use ... more Background: The dorsogluteal and ventrogluteal intramuscular injection sites both have their use in clinical practice; however, it has not been established in whom one or the other should be preferentially targeted or avoided. There is a need for an evidence-based approach towards site selection for a successful intramuscular injection outcome and to avoid unwanted injection outcomes of inadvertent subcutaneous injection or bone contact. Injection outcome is dependent on injection site subcutaneous fat thickness and muscle thickness; these are likely influenced by gender and anthropometry. Objectives: To determine whether subcutaneous fat, muscle, and total tissue thicknesses differ between the dorsogluteal and ventrogluteal sites, and whether theoretical injection outcome (intramuscular, subcutaneous, or bone contact) can be predicted by demographic and anthropometric data and described by an algorithm. Design: Cross-sectional study design. Settings: University in Australia. Participants: 145 volunteers (57% female) of at least 18 years of age recruited through the university community. Methods: Anthropometric data was collected and subcutaneous fat and muscle thicknesses were quantified by ultrasonography. Anthropometric differences between theoretical injection outcome groups (bone contact versus intramuscular versus subcutaneous at the ventrogluteal and dorsogluteal sites) was determined for each gender (ANOVA). Multiple regression analysis was conducted to determine the influence of demographic and anthropometric data on theoretical intramuscular injection outcome. An algorithm to guide site selection was developed for each gender, based on the anthropometric measures that best discriminated between injection outcomes. Results: Subcutaneous fat, muscle and total tissue were significantly thicker at the dorsogluteal site than the ventrogluteal site, and subcutaneous fat was significantly thicker in females than males at both sites (all p < 0.001); there was no gender difference for muscle or total tissue thickness at either site. Female gender, and waist and hip circumference were significant predictors of subcutaneous fat thickness at both sites; male gender was a significant predictor of dorsogluteal site muscle thickness (all p < 0.05). In the algorithm developed for site selection based on theoretical injection outcome, the best discriminators were: weight, BMI and waist circumference for females, and weight and distance between the iliac tubercle and anterior superior iliac spine for males. Conclusions: The algorithm describes when each of the ventrogluteal and dorsogluteal sites is appropriate or should be avoided, based on easily obtained anthropometric data. This has direct relevance in clinical practice in evidence-based site selection for gluteal intramuscular injections for optimal medication and health outcomes.
Morphology and anatomical relations of iliac and femoral bony landmarks, Morphology and anatomica... more Morphology and anatomical relations of iliac and femoral bony landmarks, Morphology and anatomical relations of iliac and femoral bony landmarks, gluteal muscles and the sciatic nerve: Sex differences and clinical gluteal muscles and the sciatic nerve: Sex differences and clinical implications implications
At the first meeting, Council members discussed a set of guidelines designed to focus the council... more At the first meeting, Council members discussed a set of guidelines designed to focus the council's efforts. The resulting document is excerpted below: The Council shall study and report upon the forest certification systems being used in Maine. In particular, the Council is charged with answering the following questions, though should not refrain from addressing such issues members feel are important: * http://madison.merid.org/comparison/FSC_SFI_Comp_Analysis-Exec_Summary.pdf As discussed in the following sections, there are many similarities and some differences between the two programs. Because landowners may exceed the minimum requirements of either program, differences that loom large on paper may be less apparent on the ground. These aspects as they relate to the Council's vision of a credible audit system are discussed below.
Laboratory classes are congested with factual information and demonstration (“show and tell”). St... more Laboratory classes are congested with factual information and demonstration (“show and tell”). Students, however, rarely have enough time to explore equipment and to acquire technical problem solving skills. The idea to develop a laboratory session that differed from the ...
In this paper we present a Model-Based Testing approach with which we generate tests from an abst... more In this paper we present a Model-Based Testing approach with which we generate tests from an abstraction of a source behavioural model. We show a new algorithm that computes the abstraction as an under-approximation of the source model. Our first contribution is to combine two previous approaches proposed by Ball and Pasareanu et al. to compute May, Must+ and Must-abstract transition relations. Proof techniques are used to compute these transition relations. The tests obtained by covering the abstract transitions have to be instantiated from the source model. So, following Pasareanu et al., our algorithm additionally computes a concrete transition relation: the tests obtained as sequences of concrete transitions need not be instantiated from the source model. Another contribution is to propose a choice of relevant parameters and heuristics to pilot the tests computation. We experiment our approach and compare it with a previous approach of ours to compute tests from an abstraction that over-approximates the source model.
Training simulated patients effectively is vital for the success of the patient volunteer program... more Training simulated patients effectively is vital for the success of the patient volunteer programme in the Graduate School of Medicine at the University of Wollongong. Globally, simulated patients play an essential role in contemporary medical education. Yet, there is a significant gap in the research literature regarding their training and the impact of their feedback on student learning. In 2010, our 2nd and 3rd year medical students replicated realistic interview situations as part of our simulated patient training. This intervention allowed patient volunteers to give feedback but also to receive feedback on their feedback giving skills from students. During these interactions, a strong sense of reciprocal teaching and learning between the incumbent simulated patients and the participating students emerged. Based on these observations, we conducted focus group interviews with both parties. Participants reported an enriched educational experience and better understanding of each other's role in the teaching relationship. Volunteers commented that the approach has given them a better comprehension of the expectations placed upon them by students. Students appreciated the opportunity to support volunteers in what they see as a vital aspect of their medical training.
Why do medical students volunteer to train simulated patients? A Why do medical students voluntee... more Why do medical students volunteer to train simulated patients? A Why do medical students volunteer to train simulated patients? A qualitative evaluation of motivations and incentives qualitative evaluation of motivations and incentives
One of the remaining challenges in simulation-based medical education (SBME) is to show that it h... more One of the remaining challenges in simulation-based medical education (SBME) is to show that it has a positive impact on clinical outcome (1). We report an investigation of simulation teaching in medical students using self-reported measures of change in practice as a surrogate ...
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