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2.
Medicine (Baltimore) ; 100(11): e24836, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725954

RESUMEN

ABSTRACT: Anesthesiologists and surgeons have demonstrated a lack of familiarity with professional guidelines when providing care for surgical patients with a do-not-resuscitate (DNR) order. This substantially infringes on patient's self-autonomy; therefore, leading to substandard care particularly for palliative surgical procedures. The interventional nature of surgical procedures may create a different mentality of surgical "buy-in," that may unintentionally prioritize survivability over maintaining patient self-autonomy. While previous literature has demonstrated gains in communication skills with simulation training, no specific educational curriculum has been proposed to specifically address perioperative code status discussions. We designed a simulated standardized patient actor (SPA) encounter at the beginning of post-graduate year (PGY) 2, corresponding to the initiation of anesthesiology specific training, allowing residents to focus on the perioperative discussion in relation to the SPA's DNR order.Forty four anesthesiology residents volunteered to participate in the study. PGY-2 group (n = 17) completed an immediate post-intervention assessment, while PGY-3 group (n = 13) completed the assessment approximately 1 year after the educational initiative to ascertain retention. PGY-4 residents (n = 14) did not undergo any specific educational intervention on the topic, but were given the same assessment. The assessment consisted of an anonymized survey that examined familiarity with professional guidelines and hospital policies in relation to perioperative DNR orders. Subsequently, survey responses were compared between classes.Study participants that had not participated in the educational intervention reported a lack of prior formalized instruction on caring for intraoperative DNR patients. Second and third year residents outperformed senior residents in being aware of the professional guidelines that detail perioperative code status decision-making (47%, 62% vs 21%, P = .004). PGY-3 residents outperformed PGY-4 residents in correctly identifying a commonly held misconception that institutional policies allow for automatic perioperative DNR suspensions (85% vs 43%; P = .02). Residents from the PGY-3 class, who were 1 year removed the educational intervention while gaining 1 additional year of clinical anesthesiology training, consistently outperformed more senior residents who never received the intervention.Our training model for code-status training with anesthesiology residents showed significant gains. The best results were achieved when combining clinical experience with focused educational training.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Atención Perioperativa/psicología , Medicina Perioperatoria/educación , Órdenes de Resucitación/psicología , Estudiantes de Medicina/psicología , Adulto , Anestesiología/educación , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Internado y Residencia/estadística & datos numéricos , Conocimiento , Masculino , Simulación de Paciente , Autonomía Personal , Aprendizaje Basado en Problemas , Encuestas y Cuestionarios
3.
Medicine (Baltimore) ; 100(7): e24854, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607858

RESUMEN

ABSTRACT: Malignant gastric lymphoma (MGL) accounts for a small proportion (upto 5%) of gastric malignancies. However, unlike for advanced gastric cancer (AGC) that requires surgical treatment, the standard treatments for MGL are chemotherapy and radiotherapy. Hence, the initial impression of the endoscopist is critical for the differential diagnosis and for planning future treatment. The purpose of this study was to assess the endoscopic diagnostic accuracy and the possibility of distinguishing between AGC and MGL depending on the endoscopist's experience.A total of 48 patients who had MGL, and 48 age and sex-matched patients who had AGC were assessed by endoscopic review at a tertiary referral hospital between June 2008 and February 2017. Two endoscopic specialists reviewed the endoscopic findings and divided these diagnoses into 5 groups: Borrmann type (1, 2, 3, and 4) and early gastric cancer-like type. After this, 7 experts and 8 trainees were asked to complete a quiz that was comprised of 6 images for each of the 96 cases and to provide an endoscopic diagnosis for each case. The test results were analyzed to assess the diagnostic accuracy according to the pathologic results, endoscopic subgroups, and endoscopists' experience. For inter-observer agreement was calculated with Fleiss kappa values.The overall diagnostic accuracy of endoscopic findings by the experts was 0.604 and that by the trainees was 0.493 (P = .050). There was no significant difference in the diagnosis according to the final pathology (lymphoma cases, 0.518 vs 0.440, P = .378; AGC cases, 0.690 vs 0.547, P = .089, respectively). In the subgroup analysis, the experts showed significantly higher diagnostic accuracy for the endoscopic Borrmann type 4 subgroup, including lymphoma or AGC cases, than the trainees (P = .001). Inter-observer agreement of final diagnosis (Fleiss kappa, 0.174) and endoscopic classification groups (Fleiss kappa, 0.123-0.271) was slightly and fair agreement.The experts tended to have a higher endoscopic diagnostic accuracy. Distinguishing MGL from AGC based on endoscopic findings is difficult, especially for the beginners. Even if the endoscopic impression is AGC, it is important to consider MGL in the differential diagnosis.


Asunto(s)
Endoscopía/métodos , Linfoma no Hodgkin/patología , Neoplasias Gástricas/patología , Competencia Clínica/estadística & datos numéricos , Diagnóstico Diferencial , Quimioterapia/métodos , Endoscopía/clasificación , Endoscopía/estadística & datos numéricos , Femenino , Humanos , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Radioterapia/métodos , Reproducibilidad de los Resultados , Especialización/estadística & datos numéricos , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirugía , Apoyo a la Formación Profesional/métodos , Apoyo a la Formación Profesional/estadística & datos numéricos
4.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578603

RESUMEN

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Asunto(s)
Anestesiología/educación , Educación de Postgrado en Medicina/estadística & datos numéricos , Becas/estadística & datos numéricos , Medicina de Urgencia Pediátrica/educación , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/uso terapéutico , Competencia Clínica/estadística & datos numéricos , Manejo de Datos , Educación de Postgrado en Medicina/métodos , Escolaridad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Internado y Residencia/normas , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Propofol/administración & dosificación , Propofol/uso terapéutico , Entrenamiento Simulado/estadística & datos numéricos , Encuestas y Cuestionarios
5.
Reprod Health ; 18(1): 50, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639966

RESUMEN

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Partería , Obstetricia/normas , Calidad de la Atención de Salud , Adulto , Benin/epidemiología , Lista de Verificación , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Parto Obstétrico/enfermería , Parto Obstétrico/normas , Parto Obstétrico/estadística & datos numéricos , Femenino , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Humanos , Cuidado del Lactante/normas , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Malaui/epidemiología , Partería/educación , Partería/normas , Partería/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Embarazo , Encuestas y Cuestionarios , Tanzanía/epidemiología , Uganda/epidemiología , Adulto Joven
6.
Medicine (Baltimore) ; 100(4): e24346, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530228

RESUMEN

ABSTRACT: To evaluate the learning curve of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) from the novice stage to the proficient stage, we performed retrospective study for patients with lumbar disc herniation who underwent PETLD performed by a single surgeon and evaluated the surgeon's learning curve and the effect of surgical proficiency on outcomes.A total of 48 patients who underwent PETLD at the lower lumbar level (L3-S1) with a minimum 1-year follow-up were enrolled. The learning curve of the surgeon was assessed using cumulative study of operation time and linear regression analyses to reveal the correlation between operation time and case series number.Because the cutoff of familiarity was 25 cases according to the cumulative study of operation time, the patients were allocated into two groups: early group (n = 25) and late group (n = 23). The clinical, surgical, and radiological outcomes were retrospectively evaluated and compared between the two groups.According to linear regression analyses, the operation time was obtained using the following formula: operation time (minutes) = 69.925-(0.503 × [case number]) (P < .001).As expected, the operation time was significantly different between the two groups (mean 66.00 ±â€Š11.37 min in the early group vs 50.43 ±â€Š7.52 min in the late group, P < .001). No differences were found between the two groups in demographic data and baseline characteristics. Almost all clinical outcomes (including pain improvement and patient satisfaction), surgical outcomes (including failure, recurrence, and additional procedure rates), and radiological outcomes (including change of disc height and sagittal angles) did not differ between the two groups.However, the late group demonstrated a more favorable postoperative volume index of the remnant disc (362.91 mm3 [95% confidence interval, 272.81-453.02] in the early group vs 161.14 mm3 [95% confidence interval, 124.31-197.97] in the late group, P < .001), and a lower complication rate related to exiting nerve root (16.0% in the early group vs 0% in the late group, P = .045).The learning curve of PETLD is not as difficult as that of other minimally invasive spine surgery technique. Although the overall outcomes were not different between the groups, the risks of incomplete decompression and exiting root injury-related complication were higher in the novice stage.


Asunto(s)
Discectomía Percutánea/estadística & datos numéricos , Endoscopía/estadística & datos numéricos , Desplazamiento del Disco Intervertebral/cirugía , Curva de Aprendizaje , Cirujanos/estadística & datos numéricos , Adulto , Competencia Clínica/estadística & datos numéricos , Discectomía Percutánea/educación , Discectomía Percutánea/métodos , Endoscopía/educación , Endoscopía/métodos , Femenino , Humanos , Modelos Lineales , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Cirujanos/educación , Resultado del Tratamiento
7.
BMC Fam Pract ; 22(1): 39, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596838

RESUMEN

BACKGROUND: Family medicine physicians may encounter a wide variety of conditions, including acute and urgent cases. Considering the limited access to diagnostic investigations in primary care practice, chest X-ray remains the imaging modality of choice. The current study assessed the competency of family medicine residents in the interpretation of chest X-rays for emergency conditions and to compare it with that of diagnostic radiology residents, general practitioners, and medical interns. METHODS: An online survey was distributed to 600 physicians, including family medicine residents, medical interns, general practitioners, and diagnostic radiology residents. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of chest X-rays. The survey had 10 chest X-ray cases with brief clinical information. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the chest X-ray for each case. RESULTS: The survey was completed by 205 physicians (response rate = 34.2%). The overall diagnostic accuracy was 63.1% with a significant difference between family medicine and radiology residents (58.0% vs. 90.5%; P < 0.001). The COVID-19 pneumonia (85.4%) and pneumoperitoneum (80.5%) cases had the highest diagnostic accuracy scores. There was a significant correlation between the diagnostic confidence and accuracy (rs = 0.39; P < 0.001). Multivariable regression analysis revealed that being diagnostic radiology residents (odds ratio [OR]: 13.0; 95% confidence interval [CI]: 2.5-67.7) and having higher diagnostic confidence (OR: 2.2; 95% CI: 1.3-3.8) were the only independent predictors of achieving high diagnostic accuracy. CONCLUSION: The competency of family medicine residents in the interpretation of chest X-ray for emergency conditions was far from optimal. The introduction of radiology training courses on emergency conditions seems imperative. Alternatively, the use of tele-radiology in primary healthcare centers should be considered.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Competencia Clínica/normas , Internado y Residencia/normas , Médicos de Familia/educación , Radiografía Torácica/normas , /diagnóstico por imagen , Urgencias Médicas , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Médicos de Familia/normas , Neumoperitoneo/diagnóstico por imagen , Encuestas y Cuestionarios
9.
Ann Emerg Med ; 77(3): 285-295, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33455839

RESUMEN

STUDY OBJECTIVE: Extraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ. METHODS: We assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data. An expert panel developed a novel extraglottic airway device misplacement classification system. We then applied the schema in reviewing postmortem CT for extraglottic airway device position and potential complications. RESULTS: We identified 341 eligible decedents. The median age was 47.0 years (interquartile range 32 to 59 years). Out-of-hospital personnel placed extraglottic airway devices in 265 patients (77.7%) who subsequently died out of hospital; the remainder died inhospital. The classification system consisted of 6 components: depth, size, rotation, device kinking, mechanical blockage of ventilation opening, and injury. Under the system, extraglottic airway devices were found to be misplaced in 49 cases (14.4%), including 5 (1.5%) that resulted in severe injuries. CONCLUSION: We created a novel extraglottic airway device misplacement classification system. Misplacement occurred in greater than 14% of cases. Severe traumatic complications occurred rarely. Quality improvement activities should include review of extraglottic airway device placement when CT images are available and use the classification system to describe misplacements.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Intubación Intratraqueal/instrumentación , Máscaras Laríngeas/efectos adversos , Errores Médicos/clasificación , Faringe/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Masculino , Errores Médicos/estadística & datos numéricos , Persona de Mediana Edad , Faringe/diagnóstico por imagen , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
10.
South Med J ; 114(1): 4-7, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33398352

RESUMEN

OBJECTIVE: Our primary objective was to assess the current state of pain and opioid education in obstetrics and gynecology (OBGYN) by performing a detailed review of the national educational curricula guiding OBGYN residency and fellowship training programs in the United States. METHODS: From 2019 to 2020 we reviewed seven documents created to guide learning and structure educational training for OBGYN residency and fellowship programs in the United States: the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives Core Curriculum in Obstetrics and Gynecology, the 2016 Educational Objectives-Fellowship in Minimally Invasive Gynecologic Surgery, and the 2018 Guides to Learning in Complex Family Planning, Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology and Infertility. Each document was reviewed by two authors to assess for items referring to pain or opioids. RESULTS: The CREOG educational objectives, used to inform educational curricula for residency programs, were the most comprehensive, mentioning pain and/or opioid educational objectives the highest number of times and including the most categories. The CREOG document was followed by the Guides to Learning for Gynecologic Oncology and for Minimally Invasive Gynecologic Surgery. The Reproductive Endocrinology and Infertility Guide to Learning did not mention pain and/or opioids in the educational objectives. CONCLUSIONS: Our study identifies an opportunity for consistent and appropriate opioid and pain management education in OBGYN training.


Asunto(s)
Analgésicos Opioides/efectos adversos , Analgésicos Opioides/farmacología , Curriculum/normas , Educación de Postgrado en Medicina/métodos , Obstetricia/educación , Analgésicos Opioides/administración & dosificación , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Curriculum/estadística & datos numéricos , Educación de Postgrado en Medicina/normas , Educación de Postgrado en Medicina/estadística & datos numéricos , Humanos , Obstetricia/métodos , Enseñanza/normas , Enseñanza/estadística & datos numéricos , Estados Unidos
11.
Games Health J ; 10(2): 139-144, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33434099

RESUMEN

Objective: The sudden disruption of university teaching caused by the coronavirus disease 2019 (COVID-19) pandemic has forced universities to switch to online teaching. It is vital for graduating medical students to learn about COVID-19 because they are likely to treat COVID-19 patients after graduation. We developed a COVID-19 lesson for medical students that used either an online lecture or a serious game that we designed. The aim of this study is to explore the effectiveness of a serious game versus online lectures for improving medical students' COVID-19 knowledge. Materials and Methods: From our university's database of knowledge scores, we collected the prelesson, postlesson, and final test knowledge scores of the students who participated in the lesson and conducted a retrospective comparative analysis. Results: An analysis of scores concerning knowledge of COVID-19 from prelesson and postlesson tests shows that both teaching methods produce significant increases in short-term knowledge, with no statistical difference between the two methods (P > 0.05). The final test scores, however, show that the group of students who used the game-based computer application scored significantly higher in knowledge retention than did the online lecture group (P = 0.001). Conclusion: In the context of the disruption of traditional university teaching caused by the COVID-19 pandemic, the serious game we designed is potentially an effective option for online medical education about COVID-19, particularly in terms of its capacity for improved knowledge retention.


Asunto(s)
Competencia Clínica/normas , Juegos Recreacionales/psicología , Estudiantes de Medicina/psicología , Enseñanza/normas , Análisis de Varianza , /fisiopatología , Competencia Clínica/estadística & datos numéricos , Educación a Distancia/métodos , Educación de Pregrado en Medicina/métodos , Educación de Pregrado en Medicina/normas , Educación de Pregrado en Medicina/estadística & datos numéricos , Femenino , Humanos , Conocimiento , Masculino , Estudios Retrospectivos , Estudiantes de Medicina/estadística & datos numéricos , Enseñanza/psicología , Enseñanza/estadística & datos numéricos , Adulto Joven
13.
Am J Nurs ; 121(2): 28-38, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33470615

RESUMEN

BACKGROUND: School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. METHODS: Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. RESULTS: Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural-urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. CONCLUSIONS: The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.


Asunto(s)
Conmoción Encefálica/enfermería , Competencia Clínica/normas , Servicios de Enfermería Escolar/métodos , Conmoción Encefálica/diagnóstico , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Humanos , Incidencia , Washingtón
15.
Ann Emerg Med ; 77(3): 296-304, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33342596

RESUMEN

STUDY OBJECTIVE: The bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie. METHODS: A prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt. We included all patients with a paramedic-performed intubation attempt. Logistic regression was used to examine the association between routine bougie use and first-attempt success rate. RESULTS: Paramedics attempted intubation in 823 patients during the control period and 771 during the bougie period. The first-attempt success rate increased from 70% to 77% (difference 7.0% [95% confidence interval 3% to 11%]). Higher first-attempt success rate was observed during the bougie period across Cormack-Lehane grades, with rates of 91%, 60%, 27%, and 6% for Cormack-Lehane grade 1, 2, 3, and 4 views, respectively, during the control period and 96%, 85%, 50%, and 14%, respectively, during the bougie period. Intubation during the bougie period was independently associated with higher first-attempt success rate (adjusted odds ratio 2.82 [95% confidence interval 1.96 to 4.01]). CONCLUSION: Routine out-of-hospital use of the bougie during direct laryngoscopy was associated with increased first-attempt intubation success rate.


Asunto(s)
Servicios Médicos de Urgencia/métodos , Intubación Intratraqueal/instrumentación , Laringoscopía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Técnicos Medios en Salud/normas , Técnicos Medios en Salud/estadística & datos numéricos , Competencia Clínica/estadística & datos numéricos , Servicios Médicos de Urgencia/normas , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Intubación Intratraqueal/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Adulto Joven
16.
Br J Radiol ; 94(1117): 20200520, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33095674

RESUMEN

OBJECTIVES: Life-threatening emergencies are relatively uncommon in the radiology department, but when encountered, require timely intervention. With an increasing number of critically unwell patients visiting the radiology department each year for both diagnostic and interventional procedures, it is vital that radiology staff are trained to provide basic resuscitation before further assistance arrives. Simulation training is a well-validated, effective method for rehearsing low-frequency, high-acuity events in a supportive and safe environment. The aim of our study was to investigate whether the introduction of a focussed, multidisciplinary simulation course would improve healthcare professional's knowledge and confidence when managing common medical emergencies; including cardiac arrest, anaphylaxis and airway obstruction. METHODS: A multidisciplinary group of radiology staff attended a dedicated simulation teaching course. Participants completed a pre- and post-test questionnaire which assessed a range of knowledge domains and their perceived confidence with dealing with the clinical scenarios. The delegates were then asked to repeat this questionnaire 6 months after taking part in the course to assess their retention of skills and knowledge. RESULTS: Knowledge scores increased by a mean difference of 4 points (p < 0.001). The mean pre- and post-course perceived confidence scores were 4.4/10 and 8/10, respectively. ADVANCES IN KNOWLEDGE: This study suggests that embedding simulation training into the radiology curriculum improves healthcare professional's knowledge and perceived confidence when dealing with common medical emergencies. Although previous studies have looked at the use of simulation training for radiology trainees in the management of selected medical emergencies, to the authors' knowledge, this is the first study to demonstrate these benefits across a range of clinical scenarios, within an interprofessional environment.


Asunto(s)
Urgencias Médicas , Personal de Salud/educación , Enseñanza Mediante Simulación de Alta Fidelidad/métodos , Radiología/educación , Resucitación/educación , Enfermedad Aguda , Competencia Clínica/estadística & datos numéricos , Curriculum , Humanos
17.
JAMA Netw Open ; 3(12): e2031217, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33369660

RESUMEN

Importance: Video learning prior to surgery is common practice for trainees and surgeons, and immersive virtual reality (IVR) simulators are of increasing interest for surgical training. The training effectiveness of IVR compared with video training in complex skill acquisition should be studied. Objectives: To evaluate whether IVR improves learning effectiveness for surgical trainees and to validate a VR rating scale through correlation to real-world performance. Design, Setting, and Participants: This block randomized, intervention-controlled clinical trial included senior (ie, postgraduate year 4 and 5) orthopedic surgery residents from multiple institutions in Canada during a single training course. An intention-to-treat analysis was performed. Data were collected from January 30 to February 1, 2020. Intervention: An IVR training platform providing a case-based module for reverse shoulder arthroplasty (RSA) for advanced rotator cuff tear arthropathy. Participants were permitted to repeat the module indefinitely. Main Outcomes and Measures: The primary outcome measure was a validated performance metric for both the intervention and control groups (Objective Structured Assessment of Technical Skills [OSATS]). Secondary measures included transfer of training (ToT), transfer effectiveness ratio (TER), and cost-effectiveness (CER) ratios of IVR training compared with control. Additional secondary measures included IVR performance metrics measured on a novel rating scale compared with real-world performance. Results: A total of 18 senior surgical residents participated; 9 (50%) were randomized to the IVR group and 9 (50%) to the control group. Participant demographic characteristics were not different for age (mean [SD] age: IVR group, 31.1 [2.8] years; control group, 31.0 [2.7] years), gender (IVR group, 8 [89%] men; control group, 6 [67%] men), surgical experience (mean [SD] experience with RSA: IVR group, 3.3 [0.9]; control group, 3.2 [0.4]), or prior simulator use (had experience: IVR group 6 [67%]; control group, 4 [44%]). The IVR group completed training 387% faster considering a single repetition (mean [SD] time for IVR group: 4.1 [2.5] minutes; mean [SD] time for control group: 16.1 [2.6] minutes; difference, 12.0 minutes; 95% CI, 8.8-14.0 minutes; P < .001). The IVR group had significantly better mean (SD) OSATS scores than the control group (15.9 [2.5] vs 9.4 [3.2]; difference, 6.9; 95% CI, 3.3-9.7; P < .001). The IVR group also demonstrated higher mean (SD) verbal questioning scores (4.1 [1.0] vs 2.2 [1.7]; difference, 1.9; 95% CI, 0.1-3.3; P = .03). The IVR score (ie, Precision Score) had a strong correlation to real-world OSATS scores (r = 0.74) and final implant position (r = 0.73). The ToT was 59.4%, based on the OSATS score. The TER was 0.79, and the system was 34 times more cost-effective than control, based on CER. Conclusions and Relevance: In this study, surgical training with IVR demonstrated superior learning efficiency, knowledge, and skill transfer. The TER of 0.79 substituted for 47.4 minutes of operating room time when IVR was used for 60 minutes. Trial Registration: ClinicalTrials.gov Identifier: NCT04404010.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Internado y Residencia/métodos , Procedimientos Ortopédicos/educación , Cirujanos Ortopédicos/educación , Entrenamiento Simulado/métodos , Adulto , Canadá , Femenino , Humanos , Masculino , Realidad Virtual
18.
Can J Surg ; 63(5): E396-E408, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33009899

RESUMEN

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Asunto(s)
Cirugía General/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Alcance de la Práctica/tendencias , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Canadá , Competencia Clínica/estadística & datos numéricos , Planes de Aranceles por Servicios/estadística & datos numéricos , Femenino , Cirugía General/economía , Cirugía General/educación , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Internado y Residencia/tendencias , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Servicios de Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/tendencias , Cirujanos/economía , Cirujanos/educación , Cirujanos/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/educación
19.
Obstet Gynecol ; 136(5): 987-994, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030868

RESUMEN

OBJECTIVE: To assess whether a pediatric and adolescent gynecology electronic learning (eLearning) module improves knowledge and clinical performance among obstetrics and gynecology residents. METHODS: We conducted a multi-institutional, single-blinded, randomized controlled trial across four university programs; three had pediatric and adolescent gynecology rotations, and two had pediatric and adolescent gynecology fellowship-trained faculty. Applying permutated block randomization, residents were randomized to no intervention or completion of a validated eLearning module on prepubertal bleeding. All residents subsequently completed a pediatric and adolescent gynecology-related knowledge assessment that queried understanding of prepubertal bleeding and an objective structured clinical examination that assessed history collection, performance of a prepubertal genital examination, vaginal culture, and vaginoscopy for a pediatric patient. Objective structured clinical examinations were videotaped and reviewed by two faculty, blinded to randomization group; interrater reliability score was 97%. We calculated descriptive frequencies and compared randomization groups using χ analyses and Fisher exact tests for categorical variables, and median tests for continuous variables; a value of P<.05 was considered significant. RESULTS: From July 2018 to June 2019, we invited 115 residents to participate; 97 (83%) completed both objective structured clinical examination and follow-up knowledge assessments. Most were female (91%) and the majority reported limited pediatric and adolescent gynecology didactic or clinical experience, with 36% reporting prior didactics on prepubertal vaginal bleeding and 33% reporting prior exposure to the prepubertal genital examination. Forty-five participants (46%) were randomized to the module and groups were similar across training levels. Residents assigned to the module scored significantly higher on the knowledge assessment (4/5 vs 2/5, P<.001) and objective structured clinical examination (13/16 vs 7/16, P<.001) and were more likely to avoid a speculum in the examination of a pediatric patient (95.6% vs 57.7%, P<.001). CONCLUSION: Our pediatric and adolescent gynecology eLearning module resulted in improved short-term resident knowledge and simulated clinical skills among obstetrics and gynecology residents. Applying this learning technique in other programs may help address deficiencies in pediatric and adolescent gynecology education and training.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Ginecología/educación , Internado y Residencia/estadística & datos numéricos , Pediatría/educación , Entrenamiento Simulado/métodos , Adolescente , Adulto , Niño , Curriculum , Evaluación Educacional , Becas/métodos , Becas/estadística & datos numéricos , Femenino , Ginecología/métodos , Humanos , Internado y Residencia/métodos , Pediatría/métodos , Reproducibilidad de los Resultados , Método Simple Ciego
20.
Obstet Gynecol ; 136(5): 942-949, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030877

RESUMEN

OBJECTIVE: To use the Messick validity framework for a simulation-based assessment of vaginal hysterectomy skills. METHODS: Video recordings of physicians at different levels of training and experience performing vaginal hysterectomy on a high-fidelity vaginal surgery model were objectively assessed using a modified 10-item Vaginal Surgical Skills Index, a one-item global scale of overall performance, and a pass-fail criterion. Participants included obstetrics and gynecology trainees and faculty from five institutions. Video recordings were independently assessed by expert surgeons blinded to the identities of the study participants. RESULTS: Fifty surgeons (11 faculty, 39 trainees) were assessed. Experience level correlated strongly with both the modified Vaginal Surgical Skills Index and global scale score, with more experienced participants receiving higher scores (Pearson r=0.81, P<.001; Pearson r=0.74, P<.001). Likewise, surgical experience was also moderately correlated with the modified Vaginal Surgical Skills Index and global scale score (Pearson r=0.55, P<.001; Pearson r=0.58, P<.001). The internal consistency of the modified Vaginal Surgical Skills Index was excellent (Cronbach's alpha=0.97). Interrater reliability of the modified Vaginal Surgical Skills Index and global scale score, as measured by the intraclass correlation coefficient, was moderate to good (0.49-0.95; 0.50-0.87). Using the receiver operating characteristic curve and the pass-fail criterion, a modified Vaginal Surgical Skills Index cutoff score of 27 was found to most accurately (area under the curve 0.951, 95% CI 0.917-0.983) differentiate competent from noncompetent surgeons. CONCLUSION: We demonstrated validity evidence for using a high-fidelity vaginal surgery model with the modified Vaginal Surgical Skills Index or global scale score to assess vaginal hysterectomy skills.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Evaluación Educacional/normas , Histerectomía Vaginal/educación , Entrenamiento Simulado , Cirujanos/estadística & datos numéricos , Adulto , Femenino , Ginecología/educación , Humanos , Masculino , Obstetricia/educación , Reproducibilidad de los Resultados , Cirujanos/educación
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