YEARS Algorithm Versus Wells' Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography.

OBJECTIVES: This study retrospectively applied Wells' score and YEARS algorithm to the same sample of patients to evaluate the predictive performance of each when compared with the gold standard CT pulmonary angiography. DESIGN: Retrospective analytical study. SETTING: A tertiary University Hospital in Ireland. PATIENTS: Data from 794 patients who underwent CT pulmonary angiography to rule out pulmonary embolism. INTERVENTIONS: Patients were analyzed using retrospective application of both Wells' score and YEARS algorithm. Sensitivity, specificity, and diagnostic odds ratio were calculated and compared. MEASUREMENTS AND MAIN RESULTS: Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells' score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells' score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%). CONCLUSIONS: Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.

Can saline injection protect phrenic nerve? - A randomised controlled study.

BACKGROUND AND AIMS: Various methods were attempted to reduce the incidence of phrenic nerve palsy during interscalene brachial plexus nerve block. Mechanism of phrenic palsy was presumed to be due to the spread of local anaesthetic anterior to the anterior scalene muscle. We hypothesised that by injecting saline in this anatomical location prior to performing an interscalene block might reduce the incidence of phrenic palsy. METHODS: This was a double-blinded randomised controlled study performed in a single-centre, university-teaching hospital. A total of 36 patients were randomised to either group C (conventional group) or group S (saline group). Ultrasound-guided interscalene block was administered with 20 ml of 0.25% levo-bupivacaine in both groups. Ten ml of normal saline was injected anterior to anterior scalene muscle in group S prior to performing interscalene block. A blinded radiologist performed diaphragmatic ultrasound pre- and post-operatively to document phrenic palsy. Bedside spirometry was used to perform baseline and post-operative pulmonary function test. The primary outcome was to look at the incidence of phrenic palsy as measured by diaphragmatic palsy on ultrasound performed by radiologist. Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis. RESULTS: Significantly less patients in the saline group developed diaphragmatic paresis when compared to conventional group (44% vs. 94%, Chi-squared = 10.01, P = 0.002). There was no difference in post-operative pain, subjective sensation of dyspnoea or patient satisfaction between the groups. CONCLUSION: Injecting saline anterior to anterior scalene muscle reduces the incidence of diaphragmatic palsy when performing interscalene block.

Moving beyond the technical skills and promoting professionalism-the experience of the College of Anaesthesiologists of Ireland with incorporating the Medical Council Eight Domains of Good Professional Practice into Entrustable Professional Activities.

BACKGROUND: The goal of the College of Anaesthesiologists of Ireland (CAI) is to train qualified anaesthesiologists who embody all aspects of professionalism. The Medical Council of Ireland has identified Eight Domains of Good Professional Practice which guide the standards for postgraduate specialist training, including within the CAI. AIMS: Entrustable Professional Activities (EPAs) were adopted as the organising framework for a competency-based programme within CAI. The aims were (i) to ensure that the EPA-integrated competencies from across the full range of domains and (ii) to design workplace-based assessment which fosters a culture and practice of feedback above and beyond technical skills. METHODS: Four core EPAs were developed for trialling; competencies were tagged to the eight domains in an iterative development process. Feedback Reports were devised as tools for workplace-based assessment. Analysis of the Feedback Report data revealed how well the content reflected the full range of domains. RESULTS: 'Clinical Skills' is the domain to which most competencies within the EPAs were tagged. Analysis of the content of Feedback Reports also revealed an overrepresentation of that domain. This highlighted the apparent preference of consultants and trainees for selecting clinical aspects of an EPA to provide and receive feedback on, rather than professionalism or any of the other non-technical domains. CONCLUSIONS: We advocate and make recommendations for more effective incorporation of the non-technical domains of professional practice in the processes of curriculum development, teaching, learning, feedback and assessment.