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Simulation anaesthesia

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https://www.readbyqxmd.com/read/28673217/validity-evidence-of-non-technical-skills-assessment-instruments-in-simulated-anaesthesia-crisis-management
#1
T Jirativanont, K Raksamani, N Aroonpruksakul, P Apidechakul, S Suraseranivongse
We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents...
July 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28648752/physiological-and-self-assessed-psychological-stress-induced-by-a-high-fidelity-simulation-course-among-third-year-anaesthesia-and-critical-care-residents-an-observational-study
#2
Pr Thomas Geeraerts
INTRODUCTION: The use of high-fidelity simulators in Medicine can improve knowledge, behavior and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anesthesia and critical care residents. METHODS: A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session...
June 22, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28558697/does-an-electronic-cognitive-aid-have-an-effect-on-the-management-of-severe-gynaecological-turp-syndrome-a-prospective-randomised-simulation-study
#3
Michael St Pierre, Georg Breuer, Dieter Strembski, Christopher Schmitt, Bjoern Luetcke
BACKGROUND: Lack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians' task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels...
May 30, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28520886/use-of-an-anaesthesia-workstation-barrier-device-to-decrease-contamination-in-a-simulated-operating-room
#4
S Hunter, D Katz, A Goldberg, H-M Lin, R Pasricha, G Benesh, B Le Grand, S DeMaria
Background.: Strategies to achieve reductions in perioperative infections have focused on hand hygiene among anaesthestists but have been of limited efficacy. We performed a study in a simulated operating room to determine whether a barrier covering the anaesthesia workstation during induction and intubation might reduce the risk of contamination of the area and possibly, by extension, the patient. Methods.: Forty-two attending and resident anaesthetists unaware of the study design were enrolled in individual simulation sessions in which they were asked to induce and intubate a human simulator that had been prepared with fluorescent marker in its oropharynx as a marker of potentially pathogenic bacteria...
June 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28410880/the-effect-of-user-experience-and-inflation-technique-on-endotracheal-tube-cuff-pressure-using-a-feline-airway-simulator
#5
Donna M White, José I Redondo, Alastair R Mair, Fernando Martinez-Taboada
OBJECTIVE: The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. STUDY DESIGN: Prospective, experimental clinical study. METHODS: Participants included veterinary students at the beginning (group S1) and end (group S2) of their 2-week anaesthesia rotation and veterinary anaesthetists (group A). The feline airway simulator was designed to simulate an average size feline trachea, intubated with a 4...
February 24, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28347552/learning-outcomes-evaluation-of-a-simulation-based-introductory-course-to-anaesthesia
#6
J L Rábago, M López-Doueil, R Sancho, P Hernández-Pinto, N Neira, E Capa, E Larraz, C G Redondo-Figuero, J M Maestre
OBJECTIVE: An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. MATERIAL AND METHOD: Twelve first-year anaesthesiology residents participated...
March 24, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28320312/the-effect-of-an-electronic-cognitive-aid-on-the-management-of-st-elevation-myocardial-infarction-during-caesarean-section-a-prospective-randomised-simulation-study
#7
Michael St Pierre, Bjoern Luetcke, Dieter Strembski, Christopher Schmitt, Georg Breuer
BACKGROUND: Cognitive aids have come to be viewed as promising tools in the management of perioperative critical events. The majority of published simulation studies have focussed on perioperative crises that are characterised by time pressure, rare occurrence, or complex management steps (e.g., cardiac arrest emergencies, management of the difficult airway). At present, there is limited information on the usefulness of cognitive aids in critical situations with moderate time pressure and complexity...
March 20, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28267945/validation-of-a-difficult-endotracheal-intubation-simulator-designed-for-use-in-anaesthesia-training
#8
RANDOMIZED CONTROLLED TRIAL
S Brettig, M Shurgott, S J Quinn, H Owen
There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. A total of 130 participants comprising specialists, trainees and medical students volunteered for this study. Validity was tested using randomised between-groups comparison of the time taken to intubate the manikin on all settings...
March 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28205226/an-investigation-into-the-effects-of-real-vs-stimulated-cases-and-level-of-experience-on-the-distribution-of-visual-attention-during-induction-of-general-anaesthesia
#9
T Grundgeiger, C Klöffel, S Mohme, T Wurmb, O Happel
In anaesthesia, patient simulators have been used for training and research. However, insights from simulator-based research may only translate to real settings if the simulation elicits the same behaviour as the real setting. To this end, we investigated the effects of the case (simulated case vs. real case) and experience level (junior vs. senior) on the distribution of visual attention during the induction of general anaesthesia. We recorded eye-tracking data from 12 junior and 12 senior anaesthetists inducing general anaesthesia in a simulation room and in an actual operating room (48 recordings)...
February 16, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28185262/ultrasound-guided-approach-to-nerves-direct-vs-tangential-and-the-incidence-of-intraneural-injection-a-cadaveric-study
#10
L A Sermeus, X Sala-Blanch, J G McDonnell, C A Lobo, B J Nicholls, G J van Geffen, O Choquet, G Iohom, B de Jose Maria Galve, C Hermans, M Lammens
This study evaluated the incidence of nerve puncture and intraneural injection based on the needle approach to the nerve (direct vs. tangential). Two expert operators in regional anaesthesia performed in-plane ultrasound-guided nerve blocks (n = 158) at different levels of the brachial plexus in cadavers, aiming either directly for the nerve (n = 77) or tangentially inferior to the nerve (n = 81). After reaching the outer limit of the nerve, the needle was intentionally advanced approximately 1 mm in both approaches, and 0...
April 2017: Anaesthesia
https://www.readbyqxmd.com/read/28044328/an-introduction-to-predictive-modelling-of-drug-concentration-in-anaesthesia-monitors
#11
REVIEW
J DeCou, K Johnson
A significant amount of anaesthetists' work involves the prediction of drug effects and interactions to produce a smooth general anaesthetic that minimises drug side effects and promotes rapid emergence. Successfully managing this process requires a basic understanding of drug effects, experience and inevitably some guesswork, since it is difficult (and in some cases impossible) to anticipate all relevant patient and surgical factors. Although data are generally available to allow calculation of plasma drug and effect site concentrations, this is often difficult to apply in complex clinical contexts, particularly when multiple drug types are used...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28028288/a-cost-effectiveness-analysis-of-self-debriefing-versus-instructor-debriefing-for-simulated-crises-in-perioperative-medicine-in-canada
#12
RANDOMIZED CONTROLLED TRIAL
Wanrudee Isaranuwatchai, Fahad Alam, Jeffrey Hoch, Sylvain Boet
PURPOSE: High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS: This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada...
2017: Journal of Educational Evaluation for Health Professions
https://www.readbyqxmd.com/read/27995430/eeg-artifacts-reduction-by-multivariate-empirical-mode-decomposition-and-multiscale-entropy-for-monitoring-depth-of-anaesthesia-during-surgery
#13
Quan Liu, Yi-Feng Chen, Shou-Zen Fan, Maysam F Abbod, Jiann-Shing Shieh
Electroencephalography (EEG) has been widely utilized to measure the depth of anaesthesia (DOA) during operation. However, the EEG signals are usually contaminated by artifacts which have a consequence on the measured DOA accuracy. In this study, an effective and useful filtering algorithm based on multivariate empirical mode decomposition and multiscale entropy (MSE) is proposed to measure DOA. Mean entropy of MSE is used as an index to find artifacts-free intrinsic mode functions. The effect of different levels of artifacts on the performances of the proposed filtering is analysed using simulated data...
December 19, 2016: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/27986182/episiotomy-technique-and-management-of-anal-sphincter-tears-a-survey-of-clinical-practice-and-education
#14
Rebecca Menzies, Marian Leung, Nirmala Chandrasekaran, Andrea Lausman, Michael Geary
OBJECTIVE: To ascertain current techniques of episiotomy used by obstetrics and gynaecology faculty members and residents in an academic department and to determine the current management strategies for third and fourth degree tears. METHOD: A 14-question anonymous online survey was circulated to all faculty members and residents in the University of Toronto Department of Obstetrics and Gynaecology between October 2015 and March 2016. Results were analyzed descriptively or with Fisher exact test...
December 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27930962/aiming-for-excellence-a-simulation-based-study-on-adapting-and-testing-an-instrument-for-developing-non-technical-skills-in-norwegian-student-nurse-anaesthetists
#15
Fiona M Flynn, Kjersti Sandaker, Randi Ballangrud
There is increasing focus on building safety into anaesthesia practice, with excellence in anaesthesia as an aspirational goal. Non-technical skills are an important factor in excellence and improved patient safety, though there have been few systematic attempts at integrating them into anaesthesia nursing education. This study aimed to test the reliability of NANTS-no, a specially adapted behavioural marker system for nurse anaesthetists in Norway, and explore the development of non-technical skills in student nurse anaesthetists...
January 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/27844477/videolaryngoscopy-versus-direct-laryngoscopy-for-adult-patients-requiring-tracheal-intubation
#16
REVIEW
Sharon R Lewis, Andrew R Butler, Joshua Parker, Tim M Cook, Andrew F Smith
BACKGROUND: Successful tracheal intubation during general anaesthesia traditionally requires a line of sight to the larynx attained by positioning the head and neck and using a laryngoscope to retract the tongue and soft tissues of the floor of the mouth. Difficulties with intubation commonly arise, and alternative laryngoscopes that use digital and/or fibreoptic technology have been designed to improve visibility when airway difficulty is predicted or encountered. Among these devices, a rigid videolaryngoscope (VLS) uses a blade to retract the soft tissues and transmits a lighted video image to a screen...
November 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27832555/driving-impairment-due-to-propofol-at-effect-site-concentrations-relevant-after-short-propofol-only-sedation
#17
RANDOMIZED CONTROLLED TRIAL
J L Telles, S Agarwal, J Monagle, C Stough, R King, L Downey
Australian guidelines state "Following brief surgery or procedures with short acting anaesthetic drugs, the patient may be fit to drive after a normal night's sleep. After long surgery or procedures requiring longer lasting anaesthesia, it may not be safe to drive for 24 hours or more". The increasing use of the short-acting anaesthetic drug propofol as a solitary sedative medication for simple endoscopy procedures suggests a need to review this blanket policy. Thirty patients presenting for elective day surgery were recruited as volunteers for a pre-procedure driving simulation study and randomised to propofol or placebo arms...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27807487/tibiofibula-transposition-in-high-energy-fractures
#18
Peter R Loughenbury, Rebecca A Gledhill, Nick Evans
We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27734483/speak-up-barriers-to-challenging-erroneous-decisions-of-seniors-in-anaesthesia
#19
T Beament, S J Mercer
'Speaking up' or the ability to effectively challenge erroneous decisions is essential to preventing harm. This mixed-methods study in two parts explores the concept of 'barriers to challenging seniors' for anaesthetic trainees, and proposes a conceptual framework. Using a fully immersive simulation scenario with unanticipated airway difficulty, we investigated how junior anaesthetists (one to two years of training) challenged a scripted error. We also conducted focus groups with senior trainees (three to seven years of training) and undertook a 'thematic network analysis' of responses...
November 2016: Anaesthesia
https://www.readbyqxmd.com/read/27679989/high-correlation-between-performance-on-a-virtual-reality-simulator-and-real-life-cataract-surgery
#20
Ann Sofia Skou Thomsen, Phillip Smith, Yousif Subhi, Morten la Cour, Lilian Tang, George M Saleh, Lars Konge
PURPOSE: To investigate the correlation in performance of cataract surgery between a virtual-reality simulator and real-life surgery using two objective assessment tools with evidence of validity. METHODS: Cataract surgeons with varying levels of experience were included in the study. All participants performed and videorecorded three standard cataract surgeries before completing a proficiency-based test on the EyeSi virtual-reality simulator. Standard cataract surgeries were defined as: (1) surgery performed under local anaesthesia, (2) patient age >60 years, and (3) visual acuity >1/60 preoperatively...
September 29, 2016: Acta Ophthalmologica
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