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.
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Demonstrate the feasibility of using the AirSim Bronchi airway simulator to teach residents how to manage lung isolation with double-lumen endotracheal tubes and bronchial blockers and evaluate their performance with a detailed checklist.
Prospective observational study.
University anesthesiology residency training program.
Anesthesiology residents taking a cardiothoracic anesthesiology rotation.
Residents were instructed in 7 tasks using the AirSim Bronchi: The use of the fiberoptic bronchoscope, methods for placing left and right double-lumen endotracheal tubes and 3 bronchial blockers (Univent, Arndt, and Cohen), and application of continuous positive airway pressure (CPAP) to the unventilated lung. Two to 3 weeks later, checklists and a detailed scoring system were used to assess performance. Residents rated the curriculum and their own confidence in performing the tasks using a 5-point Likert scale.
Thirteen residents completed the curriculum. Their median Likert scale ratings of the curriculum based on a questionnaire with 6 items ranged from 4 to 5 of 5. Resident confidence scores for each lung isolation technique improved after the simulation training, with the median gain ranging from 0.5 to 1.5 Likert levels depending on the task. The largest improvement occurred with the bronchial blockers (p<0.05). The median performance score for the 7 tasks combined was 88% of the maximum possible points.
The authors used the AirSim Bronchi simulator in a novel simulation curriculum to teach lung-isolation techniques to anesthesiology residents and evaluated performance using a detailed checklist scoring system. This curriculum is a promising educational tool.
Journal of cardiothoracic and vascular anesthesia 11/2013; 28(4). DOI:10.1053/j.jvca.2013.07.015 · 1.46 Impact Factor
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