Performance of novice intubators in using direct laryngoscope with 3 stylets on a manikin model.

BACKGROUND: Tracheal intubation is an important clinical skill for medical students and junior residents (novice intubators). They are usually trained to use a direct laryngoscope (DL) with straight-to-cuff styletted tracheal tubes first. Only later are they exposed to the bougie as an airway adjunct and videolaryngoscope (VL) with either a standard blade or a hyperangulated blade. The purpose of this study was to investigate the performance of novice intubators in using DL with 3 common stylets. METHODS: We conducted a prospective study to compare the performance of DL with 3 common stylets, namely the straight-to-cuff stylet (S), hyperangulated VL stylet (G), and bougie (B), on a manikin model. RESULTS: Among 72 participants, no significant difference was observed between the success rates of S, G, and B at the first attempt (84.72%, 81.94%, and 86.11%, respectively [P = .78]) or within 2 minutes (91.67%, 93.06%, and 91.67%, respectively [P = .94]). For participants with successful intubation within 2 minutes, the average total intubation times for S, G, and B were 25.05, 24.39, and 37.45 seconds, respectively. Among the 3 stylets, B had the longest intubation time, which differed significantly from S and G (P < .01). CONCLUSIONS: The performances of novice intubators with 3 different stylets were similar. The success rates for DL with either hyperangulated VL stylet or bougie were not inferior compared with the straight-to-cuff stylet on manikin airway training model. If we properly trained novice intubators to use corresponding maneuvers, they can learn to use the 3 stylets early in their airway learning course.

The roles of personality traits and negative life events on the episodes of depressive symptoms in nonreferred adolescents: a 1-year follow-up study.

PURPOSE: To evaluate the influences of personality traits and nonsevere life events on depressive episodes in a 1-year follow-up in nonreferred adolescents. METHODS: Participants were 2,773 students aged 12 to 16 years randomly selected from six middle schools in Taiwan who were assessed both at baseline for personality traits and depressive symptoms and at 1 year later for negative life events and depressive symptoms. Two, single, or no episodes of depression were based on whether the scores of the Center for Epidemiologic Studies Depression crossed over the cutoff of 28 at two time points. Multinomial logistic regression analyses were used to correlate personality or negative life events, which were trichotomized by means of tertiles or number of events, with the episodes of depressive symptoms. RESULTS: After controlling for possible confounders, only elevated neuroticism was associated with a single episode of depressive symptoms, whereas a medium level or above of neuroticism, extraversion, or negative life events all exhibited association with the occurrence of two episodes. No interactions were found between all personality traits or between personality and negative life events. CONCLUSIONS: The relations of personality traits or nonsevere life events to depressive symptoms depend on whether the episode is an initial one. A high level in neuroticism is a critical vulnerability factor for the initiation of depressive symptoms in adolescents. Once the threshold has been surpassed, the influences of various personality traits and nonsevere life events on the subsequent depressive symptoms become cumulative and exhibit a dose-response relationship.