Difficult airway simulation-based training for anaesthesiologists: efficacy and skills retention within six months.

BACKGROUND: The aim of this study was to evaluate how anaesthesiologists manage a "cannot intubate, can ventilate" (CI) and "cannot intubate, cannot ventilate" (CICV) scenarios, and how following simulation training will affect their guideline adherence, skills and decision-making immediately after training and 6 months later. METHODS: A prospective controlled study was conducted from July to December 2022. Anaesthesiologists who applied for the continuous medical education course "Difficult Airway Management" were involved in the study. Each volunteer participated in two simulation scenarios (CI, CICV) with structural debriefing after each scenario. After the first simulation round, volunteers were trained in difficult airway management according to DAS guidelines, using the same equipment as during the simulation. The participants repeated the simulation scenarios the day after the training and six months later. The primary and secondary endpoints were compared between three rounds: initial simulation (Group 1), immediately after training (Group 2), and six months after training (Group 3). RESULTS: A total of 24 anaesthesiologists consented to participate in the study and completed the initial survey form. During the first session, 83.3% of participants had at least one major deviation from the DAS protocol. During the first CICV scenario, 79% of participants made at least one deviation from the DAS protocol. The second time after simulation training, significantly better results were achieved: the number of anaesthesiologists, who attempted more than 3 laryngoscopies decreased (OR = 7 [1.8-26.8], p = 0.006 right after training and OR = 3.9 [1.06-14.4], p = 0.035 6 month later); the number, who skipped the supralaryngeal device attempt, call for help and failure to initiate surgical airway also decreased. Simulation training also significantly decreases the time to call for help, cricothyroidotomy initiation time, and mean desaturation time and increases the odds ratio of successful cricothyroidotomy (OR 0.02 [0.003-0.14], p < 0.0001 right after training and OR = OR 0.02 [0.003-0.16] 6 months after training). CONCLUSIONS: Anaesthesiologists usually display major deviations from DAS guidelines while managing CI and CICV scenarios. Simulation training improves their guideline adherence, skills, and decision-making when repeating the simulation immediately after training and 6 months later. STUDY REGISTRATION: NCT05913492, clinicaltrials.gov, 22/06/2023.

New training, new attitudes: non-clinical components in Ukrainian medical PHDs training (regarding critical thinking, academic integrity and artificial intelligence use).

OBJECTIVE: Aim: The paper studies the attitude to critical thinking, academic integrity and the Artificial Intelligence use of the Ukrainian medical PhD students. PATIENTS AND METHODS: Materials and Methods: In 2023, 56 medical PhD students from the Bogomolets National Medical University, Kyiv, Ukraine, underwent the survey. The participation was voluntary, upon the oral consent. The data included in the survey questions include various aspects related to critical thinking, analysis skills, and attitudes towards plagiarism. RESULTS: Results: A significant majority of the medical PhD students (75%) place high importance on critical thinking. While a majority (89.29%) apply analysis and critical thinking skills in their English studies, there's a notable percentage (7.14%) that is uncertain. Although most are aware of the unacceptability of cheating and plagiarism (75%), a small proportion admit to having plagiarized (12.5%). Only 30.4% of the respondents reported using GPT Chat for study. Responses to witnessing peers plagiarize or using Artificial Intelligence show a varied attitude, with many expressing unwillingness to report such incidents (30.36%). CONCLUSION: Conclusions: The survey highlights the recognized importance of critical thinking in academic study among medical PhD students, while also points to areas where attitudes and practices regarding these skills could be improved. The study shows a vast area for improvement regarding academic integrity, as almost one-third of respondents need more defined standards. This definitely puts some questions before the present medical postgraduate education, and requires change of the educational paradigm, clear rules of academic conduct, and a system of control.

Studying of psycholinguistic features of doctors' professional communication under war conditions.

OBJECTIVE: Aim: Studying of psycholinguistic features of doctors' communication competence in Ukraine under war conditions. PATIENTS AND METHODS: Materials and Methods: Bibliosemantic method; method of system analysis, comparison and generalization; empirical methods - direct observation of the doctors' and patients' living language, typology of empirical data according to socio-demographic indicators. RESULTS: Results: Within the study, 286 dialogues were collected. With voluntary consent, they were recorded in video and audio formats in compliance with ethical, bioethical, and legal norms. Next, initial typology of dialogues, their lexical and semantic analysis with identification of typical positive and negative communicative strategies were carried out. With the help of the ≪Textanz≫ specialized computer software, 48 dialogues were subjected to the content analysis procedure for two separate ≪Doctors≫ and ≪Patients≫ samples. CONCLUSION: Conclusions: The results of the analysis of ≪Doctor-Patient≫ dialogues enabled identifying and describing psycholinguistic markers of typical physiological, mental, social, and spiritual states of individuals seeking medical help under martial law. Thus, the markers of positive emotional states (optimism, confidence, empathy, etc.) and affective, negative emotional processes (anxiety, fear, anger, aggression, sadness, depression, etc.) were identified.

Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014-2021.

INTRODUCTION: The study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general and regional anaesthesia procedures affected post-operative pain in wounded soldiers. METHODS: A retrospective observational study was done based on the medical records of Ukrainian soldiers wounded in the Anti-Terrorist Operation/Operation Joint Forces between 2014 and 2021. The collected data included the American Society of Anesthesiologists score, mechanism of injury, the pattern of anatomical injury, pain intensity and the choice of anaesthesia given. Pain intensity was diagnosed using a Numerical Rating Scale. RESULTS: A total of 280 combat casualties with explosive (75.7%) and gunshot (24.3%) wound injuries were included in the study. Most of the wounded soldiers had one body region affected by injury (59.3%). In most of the cases, the affected body regions were lower (48.2%) and upper (33.8%) limbs. In 62.5% of patients, regional anaesthesia was used, while general anaesthesia was used in 37.5% of cases. The pain significantly decreased after initial treatment at the field medical unit regardless of the anaesthesia type or the number of affected body regions. CONCLUSION: Understanding the sources and anatomical patterns of war-related injuries in recent conflicts is an important element in reducing the mortality and suffering of wounded soldiers. The high percentage of injured extremities in our cohort emphasises the importance of regional anaesthesia in contemporary wars.