A Prospective Randomized Study to Evaluate a New Learning Tool for Ultrasound-Guided Regional Anesthesia.

Objective: To evaluate the effectiveness of a new learning tool for needle insertion accuracy skills during a simulated ultrasound-guided regional anesthesia procedure. Methods: Thirty participants were included in this randomized controlled study. After viewing a prerecorded video of a single, discreet, ultrasound-guided regional anesthesia task, all participants performed the same task three consecutive times (pretest), and needle insertion accuracy skills in a phantom model were recorded as baseline. All participants were then randomized into two groups, experimental and control. The experimental group practiced the task using the new tool, designed with two video cameras, a monitor, and an ultrasound machine where the images from the ultrasound and video of hand movements are viewed simultaneously on the monitor. The control group practiced the task without using the new tool. After the practice session, both groups repeated the same task and were evaluated in the same manner as in the pretest. Results: Participants in both group groups had similar baseline characteristics with respect to previous experience with ultrasound-guided regional anesthesia procedures. The experimental group had significantly better needle insertion accuracy scores ( P < 0.01) than the control group. Using the new learning tool, inexperienced participants had better needle insertion accuracy scores ( P < 0.01) compared with experienced participants. Conclusions: This study demonstrates that the use of this new learning tool results in short-term improvement in hand-eye, motor, and basic needle insertion skills during a simulated ultrasound-guided regional anesthesia procedure vs traditional practice methods. Skill improvement was greater in novices compared with experienced participants.

Twelve tips on how to establish a new undergraduate firm on a critical care unit.

BACKGROUND: Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU. AIMS: To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students. METHODS: Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized. RESULTS: Our new firm has exceeded all expectations and, based on student feedback, received the "Firm of the Year" award for several years in succession. It now serves as a model of undergraduate teaching in our hospital. CONCLUSIONS: Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate medical education.

Enterovirus infection among patients admitted to hospital in Hong Kong in 2010: epidemiology, clinical characteristics, and importance of molecular diagnosis.

The activity of hand, foot, and mouth disease (HFMD) in Hong Kong was high in 2010. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) had been performed routinely for diagnosis of enterovirus (EV) infection among hospitals in a geographical cluster. The aim of the study was to describe the epidemiology and the clinical pattern of EV-related hospital admission in 2010, and evaluate the impact of RT-PCR compared to conventional method. This was a retrospective study and patients with laboratory confirmed EV infection were included. Demographic information, clinical features, complications, and laboratory findings were analyzed. Among the 113 patients identified, HFMD was the most common presentation (84/113, 74%), followed by meningitis (10/113, 9%). Respiratory (52/113, 46%) and gastrointestinal symptoms like vomiting (36/113, 32%) and diarrhea (15/113, 13%) were quite common. For cases with central nervous system (CNS) or myocardial complications, there were significantly fewer oral ulcer and rash over hands and feet compared to their counter group. Serious infection mainly affected children younger than 1-year old and adults. Dual infection was noted among seven patients (6%). Compared to RT-PCR, conventional virus isolation detected only 14-16% of the infections. The relative low culture positive rate could be explained by the circulation of Coxsackie A6 in 2010 which was difficult to be isolated by cell culture. Diagnosis of EV infection among hospitalized patients may not be straightforward. EV RT-PCR significantly improved laboratory diagnosis and delineation of epidemiology of EV infection compared to conventional methods.

A 30-Year Worldwide Research Productivity of Scientific Publication in Full-Endoscopic Decompression Spine Surgery: Quantitative and Qualitative Analysis.

OBJECTIVE: The ever-growing number of articles related to full-endoscopic spine surgery published in the last few decades presents a challenge which is perplexing and time-consuming in identifying the current research status. The study aims to identify and analyze the most cited works related to full-endoscopic decompression spine surgery, compare the articles published by different publishers and area, and show the current publication status of full-endoscopic research. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science database between 1992 and 2022. Spine has the highest H-index with the most-cited journal in the field of full-endoscopic decompression spine surgery. China ranked as the most productive country, whereas the most cited with high H-index papers came from South Korea. For the author analysis, Yeung AT, Ruetten S, Hoogland T, Ahn Y, Choi G, and Mayer HM were the most impactful authors in the global and local citations. The most productive organization is Wooridul Spine Hospital. CONCLUSION: The bibliometric study showed a growing trend of research on full-endoscopic decompression spine surgery over the past 30 years. It has demonstrated that there is a significant increase in the number of authors, institutions, and internationally collaborated countries. However, the quality of studies is still low, and the lack of high-quality clinical evidence and the trend of general journal submissions has somewhat affected the quality of endoscopy journals in recent years.

Is there any role for thoracoscopy in the diagnosis of benign pleural effusions.

Thoracoscopy in the endoscopy suite, has a high diagnostic yield of undiagnosed pleural effusions with minimal and mild complications. Whereas relatively minimal invasive techniques, such as thoracentesis, image-guided pleural biopsy or blind pleural biopsy, can yield sufficient cell or tissue material to establish the diagnosis of the underlying condition, more definite invasive diagnostic and therapeutic procedure, such as thoracoscopy, may be required for accurate sampling and diagnosis, and further provide real-time treatment options in same procedure. If thoracoscopy is considered the gold standard for the diagnosis is a fact in case. The current review aims to provide informations on thoracoscopy indications in benign pleural diseases according to up to date publications.

Study of the anatomical variations of vertebral artery in C2 vertebra with magnetic resonance imaging and its application in the C1-C2 transarticular screw fixation.

STUDY DESIGN: Use of magnetic resonance imaging (MRI) with Constructive Interference in Steady State (CISS) sequence and isometric voxels to demonstrate the anatomic variations of vertebral artery in C2 vertebra. OBJECTIVES: To determine the transarticular screw trajectory on CISS MRI and to identify patients with anatomic variations of vertebral artery in C2 vertebra. SUMMARY OF BACKGROUND DATA: Atlantoaxial transarticular screw fixation has been reported to be biomechanically superior to other posterior techniques for atlantoaxial arthrodesis. Vertebral artery injury can be associated with catastrophic sequelae. Anatomic variation of vertebral artery is well recognized and computed tomography scan is the traditional preoperative assessment. However, no report has evaluated the use of MRI in preoperative assessment for the screw trajectories and the anatomic variation of vertebral artery. METHODS: The 3-dimensional (3D) CISS MRI with isometric voxels was performed in 30 local Chinese patients. The 3D reconstruction images were created to determine the proposed screw trajectories and their relationship with the vertebral arteries. RESULTS: In 12 patients (40%), the vertebral arteries were lying within the screw trajectories prohibiting transarticular screw fixation on at least one side. Bilateral variations with high risk of vertebral artery injuries were found in 6 patients. The remaining 6 patients had unilateral variations prohibiting the insertion of transarticular screws on one side. CONCLUSION: The 3D CISS MRI with isometric voxels is a safe and simple imaging technique to outline the vertebral arteries in C2. Reconstruction images are easily created and undistorted. It is one of the useful imaging in preoperative planning of transarticular screw fixation and determination of anatomy of vertebral artery.