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
Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242-1079, USA. European Journal of Anaesthesiology
(Impact Factor: 2.94).
11/2010; 28(3):169-74. DOI: 10.1097/EJA.0b013e328340c332
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.
Available from: Craig Ziegler
- "In this study, we developed performance measurement instruments , established a proficient competency level, trained faculty to rate the subjects' performance, and also compared two active interventions in training novices to basic proficient competency level. Although there are many excellent tools available in the literature to assist in lung isolation learning , there is no single work about how to train novices to competency level for basic skill set, and when and how to retain them. We have provided a systems-based guidance tool on how to introduce an important technical skill to novice learners, how to test them, and when to retrain for decay in skills. "
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ABSTRACT: Background: Lung isolation skills, such as correct insertion of double lumen endobronchial tube and bronchial blocker, are essential in anesthesia training; however, how to teach novices these skills is underexplored. Our aims were to determine (1) if novices can be trained to a basic proficiency level of lung isolation skills, (2) whether video-didactic and simulation-based trainings are comparable in teaching lung isolation basic skills, and (3) whether novice learners' lung isolation skills decay over time without practice. Methods: First, five board certified anesthesiologist with experience of more than 100 successful lung isolations were tested on Human Airway Anatomy Simulator (HAAS) to establish Expert proficiency skill level. Thirty senior medical students, who were naive to bronchoscopy and lung isolation techniques (Novice) were randomized to video-didactic and simulation-based trainings to learn lung isolation skills. Before and after training, Novices' performances were scored for correct placement using pass/fail scoring and a 5-point Global Rating Scale (GRS); and time of insertion was recorded. Fourteen novices were retested 2 months later to assess skill decay. Results: Experts' and novices' double lumen endobronchial tube and bronchial blocker passing rates showed similar success rates after training (P >0.99). There were no differences between the video-didactic and simulation-based methods. Novices' time of insertion decayed within 2 months without practice. Conclusion: Novices could be trained to basic skill proficiency level of lung isolation. Video-didactic and simulation-based methods we utilized were found equally successful in training novices for lung isolation skills. Acquired skills partially decayed without practice.
Available from: Mark M Guiberson
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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.
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