Training in placement of the left-sided double-lumen tube among non-thoracic anaesthesiologists: Intubation model simulator versus computer-based digital video disc, a randomised controlled trial
ABSTRACT To compare the effectiveness of training with an airway model simulator versus digital video disc (DVD)-based instruction in placement of double-lumen endotracheal (DLT) tubes by anaesthesiologists with limited thoracic experience.
Single academic centre parallel randomised controlled trial with computer-generated random allocation.
Sixty patients undergoing elective thoracic or oesophageal surgeries requiring one-lung ventilation. Twenty-seven non-thoracic anaesthesiologists were randomised to place a DLT.
DLT placement instruction by an interactive airway simulator or computer-based DVD training. The main outcome measure was successful DLT placement.
Twenty-seven anaesthesiologists were randomised to one of the two intervention groups. Sixty consecutive patients were assigned to a randomised anaesthesiologist (n = 30 in each group). Participants failed to correctly place or position the DLT tubes in 14 of 60 patients (failure rate of 23%). There was no difference in the probability of satisfactory placement or time for positioning of the DLT between the training groups; 80.5% (95% confidence interval 58.2-96.2%) of tubes were successfully placed following intubation model simulator training versus 73.6% (95% confidence interval 49.8-88.5%) in the DVD group (P = 0.378).
Both teaching methods had similar outcomes for placement of DLTs by anaesthesiologists with limited thoracic anaesthesia experience. Both groups performed better than individuals in our prior study. Therefore, these methods should be considered when training anaesthesiologists to successfully place DLTs.
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ABSTRACT: The purpose of the current study was to examine the concurrent validity and classification accuracy of 3 parent report measures of language development in Spanish-speaking toddlers. Forty-five Spanish-speaking parents and their 2-year-old children participated. Twenty-three children had expressive language delays (ELDs) as determined through multiple sources of information, and 22 had typical language development (TD). Parents completed the Spanish version of the Ages and Stages Questionnaire (Spanish ASQ; Squires, Potter, & Bricker, 1999) and the short-form of the Inventarios del Desarrollo de Habilidades Comunicativas Palabras y Enunciados (INV-II; Jackson-Maldonado, Bates, & Thal, 1992; Jackson-Maldonado et al., 2003), which is the Spanish version of the MacArthur-Bates Communicative Development Inventories Words and Sentences form, and reported children's 3 longest utterances (M3L-W). Children were administered the Preschool Language Scale, Fourth Edition, Spanish Edition (SPLS-4; Zimmerman, Steiner, & Pond, 2002) at early childhood centers. All 3 parent report measures were significantly correlated with the SPLS-4, establishing their concurrent validity. Children with ELDs scored significantly lower than TD children on all 3 parent report measures. The Spanish ASQ demonstrated less than desirable levels of sensitivity and specificity; both the short-form INV-II and M3L-W measures demonstrated favorable sensitivity and specificity. Of these measures, M3L-W demonstrated the strongest classification accuracy qualities, including sensitivity, negative predictive value, and area under the receiver operating characteristics curve. The short-form INV-II and M3L-W demonstrated highly satisfactory classification accuracy of ELDs, but M3L-W demonstrated slightly stronger accuracy. These results indicate that these measures may be useful in screening for ELDs in Spanish-speaking toddlers.Language Speech and Hearing Services in Schools 08/2011; 42(4):536-49. DOI:10.1044/0161-1461(2011/10-0076) · 1.32 Impact Factor
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ABSTRACT: OBJECTIVES: Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. DATA SOURCES: Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. STUDY ELIGIBILITY: Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction. APPRAISAL AND SYNTHESIS: Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. RESULTS: From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78). LIMITATIONS: Focused field in education; high inconsistency (I(2) > 50 % in most analyses). CONCLUSIONS: Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.Journal of General Internal Medicine 04/2013; 28(8). DOI:10.1007/s11606-012-2264-5 · 3.42 Impact Factor
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ABSTRACT: To perform a systematic review and meta-analysis of the literature on teaching airway management using technology-enhanced simulation. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. Observational or controlled trials instructing medical professionals in direct or fiberoptic intubation, surgical airway, and/or supraglottic airway using technology-enhanced simulation were included. Two reviewers determined eligibility. Study quality, instructional design, and outcome data were abstracted independently and in duplicate. Of 10,904 articles screened, 76 studies were included (n = 5,226 participants). We used random effects meta-analysis to pool results. In comparison with no intervention, simulation training was associated with improved outcomes for knowledge (standardized mean difference, 0.77 [95% CI, 0.19-1.35]; n = 7 studies) and skill (1.01 [0.68-1.34]; n = 28) but not for behavior (0.52 [-0.30 to 1.34]; n = 4) or patient outcomes (-0.12 [-0.41 to 0.16]; n = 4). In comparison with nonsimulation interventions, simulation training was associated with increased learner satisfaction (0.54 [0.37-0.71]; n = 2), improved skills (0.64 [0.12-1.16]; n = 5), and patient outcomes (0.86 [0.12-1.59]; n = 3) but not knowledge (0.29 [-0.28 to 0.86]; n = 4). We found few comparative effectiveness studies exploring how to optimize the use of simulation-based training, and these revealed inconsistent results. For example, animal models were found superior to manikins in one study (p = 0.004) using outcome of task speed but inferior in another study in terms of skill ratings (p = 0.02). Five studies comparing simulators of high versus low technical sophistication found no significant difference in skill outcomes (p > 0.31). Limitations of this review include heterogeneity (I > 50% for most analysis) and variation in quality among primary studies. Simulation-based airway management curriculum is superior to no intervention and nonsimulation intervention for important education outcomes. Further research is required to fine-tune optimal curricular design.Critical care medicine 11/2013; 42(1). DOI:10.1097/CCM.0b013e31829a721f · 6.15 Impact Factor