Abstract:

This paper traces a four month medical history of a patient:
1) from her complaints starting with a sinus infection and then followed by constipation and lower back pain,
2) through the diagnosis and repair of two compression fractures at L1 and T12 vertebrae,
3) to the long term plan for treating her bone loss and
4) finally to the prognosis.

During this time the patient had two office visits to a family practice MD, one visit to a pain specialist MD, seven visits to a spine surgeon and two visits to an internal medicine MD. The patient also started physical therapy after the first kyphoplasty; however, it was stopped because of the second compression fracture. The patient had two kyphoplasty procedures, a spine biopsy, numerous x-rays and lab tests. Of special interest for this study were the large amount of patient diagnostic data, including x-rays, MRIs and bone-density test that became available for teaching purposes. This paper traces the diagnostic process of determining which disease or condition explains a patient’s signs and symptoms. The differential diagnosis is finding as many candidate diseases or conditions as possible that share similar signs or symptoms, followed by a process of elimination. The prognosis is determined after completing the diagnostic process and is the forecast of the likely outcome of a disease or condition. The Systems Management and Production Center at the University of Alabama in Huntsville (UAH) had been working with the College of Nursing in developing 3D printed models for nursing education. One of the projects was the development of 3D printed models of this patient’s two compression fractures of L1 and T12. Since the compression fracture at T12 occurred after the fracture at L1, MRIs and x-rays were available that showed the before and after the kyphoplasty procedures. 3Dslicer and 3Dbuilder software were used to convert the MRIs into the STL format for 3D printing. The 3Dbuilder software included 3D computer models of the compression fractures that were easy to rotate and enlarge, thus allowing nursing students the ability to study and analyze the compression fractures and the kyphoplasty procedures. Simulation based learning experiences (SBLEs) occur in a simulation laboratory where nursing students engage in activities designed around a set of learning objectives. These activities are developed into simulation scenarios. A scenario contains the learning objective, patient (could be a mannequin) information (background, current condition, and medications), actor scripts as needed, timeline for the scenario and cues needed by the facilitator to assist the action. The College of Nursing has developed over one-hundred SBLEs for training nurses. This case study provided an excellent supplement to these SBLEs. The 3Dbuilder computer models have been placed on the College of Nursing's (MEDNET) website so nursing students can access the software at any time as part of their SBLE. Included in this paper is the diagnostic process; a detailed description of the patient’s medical events through the prognosis; the compression fractures and kyphoplasty; the x-rays, MRIs, 3D printing and 3D computer simulation supporting the diagnosis process, the integration of this case study in the College of Nursing's SBLEs and conclusions.

Keywords:

Medical diagnosis, 3D printing, compression fracture, MRI, simulation based learning experiences.