Loss of resistance: A randomised controlled trial assessing four low-fidelity epidural puncture simulators.

BACKGROUND: Detecting loss of resistance (LOR) can either be taught with dedicated simulators, with a cost ranging from &OV0556;1500 to 3000, or with the 'Greengrocer's Model', requiring simply a banana. OBJECTIVES: The purpose of this study was to compare three dedicated epidural puncture training simulators and a banana in their ability to simulate LOR. Our hypothesis was that there was a difference between the four simulators when comparing the detection of LOR. DESIGN: Single-blinded, randomised, controlled study. SETTING: Department of Anaesthesiology and Pain Therapy, Bern University Hospital, Switzerland. PARTICIPANTS: Fifty-five consultant anaesthesiologists. INTERVENTIONS: The participants were asked to insert an epidural catheter in four different epidural puncture training simulators: Lumbar Puncture Simulator II (Kyoto Kagaku, Kyoto, Japan), Lumbar Epidural Injection Trainer (Erler-Zimmer, Lauf, Germany), Normal Adult Lumbar Puncture/Epidural Tissue (Simulab Corp., Seattle, Washington, USA) and a banana. The simulators were placed in identical boxes to blind the participants. MAIN OUTCOME MEASURES: The primary outcome was the detection of LOR rated on a 100-mm visual analogue scale, in which 0 mm represented 'completely unrealistic' and 100 mm represented 'indistinguishable from a real patient'. RESULTS: The mean visual analogue scale scores for LOR in the four simulators were significantly different: 60 ±â€Š25 mm [95% confidence interval (CI), 55 to 65 mm], 50 ±â€Š29 mm (95% CI, 44 to 55 mm), 64 ±â€Š24 mm (95% CI, 58 to 69 mm) and 49 ±â€Š32 mm (95% CI, 44 to 54 mm); P less than 0.001, Friedman test. CONCLUSION: Two of the three dedicated epidural simulators were rated more realistic in detecting LOR than the banana, but some participants preferred the banana to the other three simulators. Given the relative cost of a banana compared with a dedicated simulator, we suggest that a banana be used to teach the technique of LOR for epidural puncture. TRIAL REGISTRATION: KEK Nr: Req-2015-z087.

The German interprofessional attitudes scale: translation, cultural adaptation, and validation.

Objectives: The implementation of obstetric hybrid simulation and interprofessional collaboration between midwives and anesthetists in labor emergencies fostered the need to evaluate the impact of such a program. The original Interprofessional Attitude Scale (IPAS) assesses interprofessional attitudes among health professional students and includes the 2011 and 2016 Interprofessional Collaborative Practice report competency domains. The purpose of this study was to create a German version of the IPAS (G-IPAS) to use for the education of healthcare students. Methods: We performed the translation and validation of the IPAS in five steps: translation to German according to the International Society of Pharmaeconomics and Outcome Research guidelines; nine cognitive interviews with healthcare professionals and students;calculation of the Content Validity Index (CVI) by expert opinion; exploratory factor analysis (EFA); and internal consistency by Cronbach's alpha. All study participants gave written informed consent and the cantonal ethics committee waived further ethical approval. Results: The cognitive interviews led to replacement of single-item wording. We retained 27 items for CVI analysis. The averaged overall CVI was 0.79, with 15 items ≥0.89. 185 students (70 medicine, 51 nursing, 48 physiotherapy, and 16 midwifery) contributed with data for the EFA and it produced three subscales. "Teamwork, roles, and responsibilities" with factor loadings ≥0.49, "Patient-centeredness" with factor loadings ≥0.31, and "Community-centeredness" with factor loadings ≥0.57. Two items of the total scale were deleted, and four items were redistributed to another subscale. Cronbach's alpha for the overall G-IPAS scale was 0.87. After deleting and redistributing items in subscales, a new Scale-CVI/Average was calculated and was 0.82. Conclusions: Based on a rigorous validation process, the G-IPAS provides a reliable tool to assess attitudes towards interprofessional education among different healthcare professions in German-speaking countries.