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ABSTRACT: Fibreoptic intubation is an essential skill in anaesthesiology that is challenging to learn in the clinical setting. The goal of this study was to evaluate 'virtual fibreoptic intubation' (VFI) software as an adjunct to the traditional fibreoptic intubation teaching.
After informed consent, 42 undergraduate medical students were randomized into two groups. The 'control group' was taught conventionally by an expert bronchoscopist with a 1 h lecture. In addition to the didactic lecture by the expert, the 'VFI group' was given the VFI CD-ROM, and students self-trained with the software until they felt competent performing a virtual fibreoptic bronchoscopy on the normal patient models. Students were evaluated 2 weeks later on their first orotracheal fibreoptic intubation of an airway manikin. The primary endpoint was success, as evaluated by a staff anaesthesiologist blinded to the group of teaching. Fibreoptic intubation ability was the secondary endpoint.
The fibreoptic intubation success rate was significantly higher in the VFI group than in the control group (81 versus 52%, P < 0.05). Among 10 failures in the control group, nine were due to oesophageal intubation as compared with only one out of four in the VFI group. Among four failures in the VFI group, three were because of taking longer than 4 min as compared with only one out of 10 in the control group. The VFI group tended towards better ability in the procedural skills of fibreoptic intubation than the control group.
Self-training in fibreoptic intubation with the VFI software may improve the acquisition of fibreoptic intubation skills.
European Journal of Anaesthesiology 10/2009; 27(1):31-5. · 2.23 Impact Factor
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Canadian Journal of Anaesthesia 02/2009; 56(1):14-8. · 2.35 Impact Factor
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ABSTRACT: To compare the self-perceived sleepiness of Canadian anesthesia residents providing modified on-call duties (12-16 h) vs. traditional on-call duties (24 h).
A 25-item online survey was distributed to all Canadian anesthesia residents who, at that time, were on anesthesia rotations. The survey assessed resident demographics, perceived work patterns, and sleepiness, as well as their opinions on resident work hour reform. Self-perceived sleepiness was quantified using the validated Epworth sleepiness scale (ESS).
Three hundred eight of 400 (77%) eligible Canadian anesthesia residents completed the survey. Forty-three percent of residents who worked traditional on-call (duration 24.1 +/- 0.5 h) shifts and 48% of residents who worked modified on-call (duration 15.5 +/- 1.8 h) shifts met ESS criteria for excessive daytime sleepiness. Overall mean ESS scores did not differ significantly between the traditional (9.1 +/- 4.9) and the modified call groups (9.5 +/- 4.8). Residents with an on-call frequency of >or=1:4 days or those who slept <or=2 h while on call perceived themselves as significantly more sleepy (P = 0.045 and P = 0.008, respectively). Six percent of residents admitted to taking "something other than caffeine" to stay awake on call.
Many anesthesia residents do exhibit excessive daytime sleepiness, with a similar incidence for those working within either modified or traditional call systems. Our study suggests that sleepiness may be reduced by scheduling on-call duties no more frequently than one in every five nights and by ensuring that residents sleep more than 2 h while on call.
Canadian Journal of Anaesthesia 01/2009; 56(1):27-34. · 2.35 Impact Factor
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ABSTRACT: To evaluate the intra- and inter-observer reproducibility of the Gartland radiographic classification for supracondylar humeral fractures in children.
Anteroposterior and lateral radiographs of 50 supracondylar humeral fractures in children were graded on 2 separate occasions by 4 orthopaedic surgeons according to the Wilkins modification of the Gartland classification. Data were analysed by calculating the Kappa values for intra- and inter-observer agreement to indicate the reproducibility of the classification.
There was moderate inter-observer agreement, except for poor agreement over type I fractures. Type II fractures only showed fair to moderate agreement. Type III fractures and the flexion group showed good to very good agreement. Intra-observer agreement was good to very good.
Surgeons should treat paediatric supracondylar humeral fractures based on an assessment of the degree of displacement rather than by employing the Gartland classification.
Journal of orthopaedic surgery (Hong Kong) 05/2007; 15(1):12-4.
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ABSTRACT: Seven hundred and sixty-eight children with displaced forearm fractures requiring reduction were studied retrospectively. Of 38 refractures (incidence 4.9%), 34 occurred within nine months at the original fracture site. The median time to refracture was eight weeks after discontinuing cast immobilisation. Diaphyseal fractures were eight times more likely to refracture than metaphyseal fractures. The risk of refracture was inversely proportional to the duration of cast immobilisation. Cast immobilisation for a minimum of six weeks reduces the risk of refracture by a factor of between four and six. Midshaft forearm fractures are at risk of refracture for sixteen weeks from cast removal.
Injury 12/1999; 30(9):583-6. · 1.98 Impact Factor
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ABSTRACT: To assess the accuracy and reproducibility of a digital image analyser and the human eye, in measuring radiographic dimensions.
We experimentally compared radiographic measurement using either an image analyser system or the human eye with digital caliper.
The assessment of total hip arthroplasty wear from radiographs relies on both the accuracy of radiographic images and the accuracy of radiographic measurement.
Radiographs were taken of a slip gauge (30+/-0.00036 mm) and slip gauge with a femoral stem. The projected dimensions of the radiographic images were calculated by trigonometry. The radiographic dimensions were then measured by blinded observers using both techniques.
For a single radiograph, the human eye was accurate to 0.26 mm and reproducible to +/-0.1 mm. In comparison the digital image analyser system was accurate to 0.01 mm with a reproducibility of +/-0.08 mm. In an arthroplasty model, where the dimensions of an object were corrected for magnification by the known dimensions of a femoral head, the human eye was accurate to 0.19 mm, whereas the image analyser system was accurate to 0.04 mm.
The digital image analysis system is up to 20 times more accurate than the human eye, and in an arthroplasty model the accuracy of measurement increases four-fold. We believe such image analysis may allow more accurate and reproducible measurement of wear from standard follow-up radiographs.
Clinical Biomechanics 08/1999; 14(6):434-7. · 2.07 Impact Factor
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ABSTRACT: This study was devised to determine whether blood loss for sequential bilateral knee arthroplasties was the same for the first and second knees. Twenty-eight patients who underwent this procedure were studied along with a control group of patients who underwent unilateral knee arthroplasties. Blood loss was greater in the second knee by a mean of 323 mL (P < .05). The control group and the first knee showed no significant difference in blood loss. Analysis of clotting studies showed a prolongation of prothrombin time, activated partial thromboplastin time, and thrombin time after release of the first tourniquet. Possible reasons for this greater blood loss are discussed.
The Journal of Arthroplasty 01/1998; 13(1):77-9. · 2.38 Impact Factor
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Journal of accident & emergency medicine 07/1994; 11(2):136-7.
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ABSTRACT: Septic arthritis of the hip joint can be difficult to detect clinically and usually requires a formal arthrotomy for adequate drainage and debridement of the joint. This case report presents a patient for whom the diagnosis and treatment were performed arthroscopically. This technique allows isolation of the organism as well as the opportunity to irrigate, lavage, and debride the joint through a small puncture wound only.
Arthroscopy The Journal of Arthroscopic and Related Surgery 02/1993; 9(6):707-8. · 3.02 Impact Factor
