Jolly Meenakshi, Hill Aunita, Mataria Mohammad, Agarwal Shri
Department of Medicine, Christ Medical Center, Oaklawn, Illinois, USA.
J Rheumatol. 2007 Jul;34(7):1576-9. Epub 2007 May 15.
To assess the effect of an intervention workshop designed to improve intraarticular (IA) and periarticular (PA) injection skills among primary care physicians.
An interactive joint model injection workshop was designed for family practice and internal medicine residents and faculty, aimed at improving their skill performing IA and PA procedures. The workshop covered indications, contraindications, complications and supplies required to perform procedures, formulations of steroidal preparations, volumes used for injection, skin preparation, method of needle insertion, synovial fluid aspirations, aftercare, and processing of the synovial fluid. Interactive prewired models of shoulders, wrist, hand, knee, ankle, and foot provided feedback with an audible buzz for correctly performed procedure. A survey was administered immediately following the workshop and after 10 months.
Of 60 participants, 39% were residents and 21% faculty. The mean age (+/- SD) of participants was 32.7 +/- 7.7 years. The mean duration of followup was 10.5 months. The mean +/- SD comfort scores on theoretical and practical aspects of the procedures surveyed prior to the workshop were 4.8 +/- 2.5 and 4.4 +/- 2.5, respectively; and after the workshop were 8.0 +/- 1.7 (p = 0.001) and 7.8 +/- 1.7 (p = 0.001), respectively. The mean change in comfort scores in practical aspects of IA and PA procedures did not correlate with the age of participants, but rather with their training/faculty status (p = 0.01). The mean changes in comfort scores with practical aspects of these procedures were highest among first-year residents (4.5+/- 2.1), followed by faculty (3.1 +/- 1.7). On followup, the mean comfort scores on theoretical and practical aspects of the procedures were 6.3 +/- 1.7 and 6.0 +/- 1.8, respectively, significantly higher than the pre-workshop scores (p = 0.03, p = 0.02).
Joint injection workshops using interactive joint models can improve the comfort scores of physicians learning IA and PA injection skills, in both theoretical and practical aspects of the procedure. Faculty and first-year residents in training seem to benefit the most; significant improvement in comfort scores was seen across the spectrum of physicians. Thus acquired comfort with knowledge and practical aspects of joint procedures may undergo attrition over time; however, significant residual benefits are still appreciable over time.
评估一个旨在提高基层医疗医生关节内（IA）和关节周围（PA）注射技能的干预性研讨会的效果。
为家庭医学和内科住院医师及教员设计了一个交互式关节模型注射研讨会，旨在提高他们进行IA和PA操作的技能。该研讨会涵盖了操作的适应证、禁忌证、并发症、所需用品、甾体类制剂的配方、注射用量、皮肤准备、进针方法、滑液抽吸、术后护理以及滑液的处理。肩部、腕部、手部、膝部、踝部和足部的交互式预连线模型会在操作正确时发出可听见的嗡嗡声以提供反馈。在研讨会结束后立即以及10个月后进行了一项调查。
60名参与者中，39%为住院医师，21%为教员。参与者的平均年龄（±标准差）为32.7±7.7岁。平均随访时间为10.5个月。在研讨会前对操作的理论和实践方面进行调查的平均舒适度评分（±标准差）分别为4.8±2.5和4.4±2.5；研讨会后分别为8.0±1.7（p = 0.001）和7.8±1.7（p = 0.001）。IA和PA操作实践方面舒适度评分的平均变化与参与者的年龄无关，而是与他们的培训/教员身份有关（p = 0.01）。这些操作实践方面舒适度评分的平均变化在一年级住院医师中最高（4.5±2.1），其次是教员（3.1±1.7）。在随访中，操作的理论和实践方面的平均舒适度评分分别为6.3±1.7和6.0±1.8，显著高于研讨会前的评分（p = 0.03，p = 0.02）。
使用交互式关节模型的关节注射研讨会可以提高医生在学习IA和PA注射技能时在操作的理论和实践方面的舒适度评分。教员和一年级住院医师似乎受益最大；各类医生的舒适度评分均有显著提高。因此，随着时间的推移，通过这种方式获得的对关节操作知识和实践方面的舒适度可能会逐渐降低；然而，随着时间的推移，仍有显著的残余益处。
