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Cai X, Yue M, Liu X, Zhang L, Wu S, Shen W, Yu A. Learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents: A cumulative sum analysis. PLoS One 2023; 18:e0288617. [PMID: 37440528 DOI: 10.1371/journal.pone.0288617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency. METHODS This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation. RESULTS Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation. CONCLUSIONS Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees. TRIAL REGISTRATION Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.
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Affiliation(s)
- Xingzhi Cai
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Mingming Yue
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xiaohui Liu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Lize Zhang
- Shanddong First Medical University, Shandong, China
| | - Shanshan Wu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Wenlong Shen
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Ailan Yu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Achieving Lumbar Epidural Block Competency in Inexperienced Trainees after a Structured Epidural Teaching Model: A Randomized, Single Blind, Prospective Comparison of CUSUM Learning Curves. Anesthesiol Res Pract 2022; 2022:1738783. [PMID: 36092854 PMCID: PMC9463033 DOI: 10.1155/2022/1738783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Aim The aim of this randomized, prospective study was to investigate whether the use of the structured epidural teaching model (SETM) may affect the learning curve for lumbar epidural block in novice trainees when compared with a standard teaching module. Introduction There is a paucity of literature regarding the efficacy of teaching epidural blocks and comparisons between the different educational approaches. Method Forty-four PGY3 anesthesia trainees were randomized to receive (study group) or to not receive (control group) the SDM (structured didactic model) before the beginning of their 6 months clinical practice rotation in labor and delivery suites. A CUSUM learning curve was built for every trainee. The scores were assigned by the staff instructor, who was unaware of the group to which the trainee belonged. Results The number of subjects who achieved an improvement in performance was 8 trainees from the control group and 14 from the study group. The probability of achieving an improvement was higher (p < 05) in the study group than in the control group, with an aOR of 3.25 (CI: 1.01; 12.1). The proportion of subjects in the study group who completed the epidural without help was 1.21 (1.05–1.41) times the proportion of subjects who completed the epidural without help in the control group. The probability of completing the epidural block without any assistance was 21% higher in the study group than in the control group (p < 05). Conclusion We have demonstrated that the use of the structured epidural teaching model (SETM) may improve the learning curve (CUSUM) for lumbar epidural block in novice, entirely inexperienced, anesthesia trainees.
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Philip CA, Sandré A, de Saint-Hilaire P, Cortet M, Dubernard G. Learning Curve for the Detection of Deep Infiltrating Endometriosis and Adenomyosis with 3-D Transvaginal Water Contrast Sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1328-1335. [PMID: 35469632 DOI: 10.1016/j.ultrasmedbio.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Three-dimensional rectosonography (RSG) is a transvaginal sonography technique using rectal water contrast and 3-D acquisitions. The main points of interest of 3-D RSG could be its easy accessibility and its quick learning curve, especially with respect to rectosigmoid lesions. The objective of this prospective observational study was to assess the learning curve of 3-D RSG for the diagnosis of rectosigmoid lesions and for various other locations of deep endometriosis (DE), endometriomas and adenomyosis. From April 2017 to November 2017, 116 patients with suspected pelvic endometriosis were referred to the Croix-Rousse University Hospital, and those who underwent 3-D RSG were included in our study. After a short training period, four residents were asked to perform 3-D RSG by themselves. Each procedure was systematically controlled immediately afterward by a single expert sonographer. The success of the procedure involved the correct identification of various locations of endometriosis (rectosigmoid, uterosacral ligament, retrocervical space, vagina, bladder and ovaries) and adenomyosis, using the expert sonographer's examination as the reference technique. The learning curve was generated using these data and assessed using the Learning Curve Cumulative Summation Test (LC-CUSUM) method. The pooled LC-CUSUM revealed that the required level of achievement was reached after 24 3-D RSGs were performed for the diagnosis of rectosigmoid lesions. All four residents were significantly competent in diagnosing rectosigmoid lesions at the end of their training period, with an α risk <0.05 (T1, p = 0.03; T2, p = 0.0002; T3, p = 0.05; T4, p = 0.02). The LC-CUSUM analysis confirmed that competency was achieved for vaginal DE, torus uterinum DE, US DE, bladder DE, endometriomas and adenomyosis within 17, 27, 38, 19, 17 and 33 scans, respectively. This study provides evidence that the skills required to diagnose endometriosis lesions and adenomyosis with 3-D RSG can be acquired after a brief learning period in an expert center.
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Affiliation(s)
- Charles-André Philip
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Amélie Sandré
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre de Saint-Hilaire
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France
| | - Marion Cortet
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Gil Dubernard
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
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Narayanasamy S, Ding L, Yang F, Gunter J, Samuels P, Mecoli M. Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures. Can J Anaesth 2021; 69:256-264. [PMID: 34755274 DOI: 10.1007/s12630-021-02149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. METHODS We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. RESULTS Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. CONCLUSION Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.
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Affiliation(s)
- Suryakumar Narayanasamy
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA.
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Fang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Joel Gunter
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Paul Samuels
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
| | - Marc Mecoli
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2001, Cincinnati, OH, 45229, USA
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Uludağ Yanaral T, Karaaslan P. Evaluation of the learning curve of pediatric kidney transplantation anesthesia. Turk J Med Sci 2021; 51:1234-1239. [PMID: 34013706 PMCID: PMC8283487 DOI: 10.3906/sag-2012-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background/aim Pediatric kidney transplantation (PKT) anesthesia brings some different challenges than adult kidney transplantation (KT) anesthesia and there are still no studies analyzing the role of experience on PKT outcomes. In this study, we aimed to evaluate the anesthesia learning curve in pediatric kidney transplants performed in our institution and the effect of increasing experience on renal transplantation-related data. Materials and methods Patients age ≤ 18 years who underwent KT were included in the study, while patients age >18 years were excluded. Patients were divided into 3 groups according to the date of transplant, as the first 10 patients in Group 1, the second 10 patients in Group 2, and the final 11 in Group 3. Groups were compared according to recorded data. Results Thirty-one patients were included in the study. Age, sex, and body mass index were matched between the 3 groups. The mean durations of dialysis were 75.0 ± 63.0, 22.4 ± 27.9, and 5.7 ± 4.5 months for Group 1, Group 2, and Group 3, respectively (p = 0.009). Blood loss, duration of postoperative mechanical ventilation, and length of stay in the intensive care unit (ICU) were comparable between the groups. The duration of anesthesia gradually shortened from Group 1 to Group 3 but there was no significant difference between the groups. The mean number of red blood cell (RBC) transfusion was 0.9 ± 0.7 unit in group 1. It decreased to a mean of 0.6 ± 0.7 unit for group 2, and afterward significant decrease occurred down to 0 for group 3 (p = 0.004). Conclusion Our results demonstrate that considering the decrease in preoperative dialysis duration and operative RBC transfusion, 20 patients may be enough for anesthesia competency. Transplantation anesthesia experience before PKT, anesthesia technique, and patient characteristics may differ between institutions. Therefore, further prospective studies with established learning curve goals, larger patient volumes, and more variables are needed to validate our results.
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Affiliation(s)
- Tümay Uludağ Yanaral
- Department of Anesthesiology and Reanimation, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Pelin Karaaslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
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Verhaeghe C, El Hachem H, Inchboard L, Corroenne R, Dreux C, Jeanneteau P, Legendre G, Descamps P, Saulnier P, May-Panloup P, Bouet PE. Assessment of operator performance during oocyte retrievals: residents' learning curve and continuous monitoring of senior physicians. BMC MEDICAL EDUCATION 2021; 21:193. [PMID: 33823830 PMCID: PMC8025573 DOI: 10.1186/s12909-021-02615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. METHODS We performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency. RESULTS Six hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically "suboptimal" OR, and one physician (20%) had two suboptimal retrievals. CONCLUSION There is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.
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Affiliation(s)
- C Verhaeghe
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France.
| | - H El Hachem
- Department of Reproductive Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - L Inchboard
- Clinical Research Center, Angers University Hospital, Angers, France
| | - R Corroenne
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - C Dreux
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Jeanneteau
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - G Legendre
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Descamps
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Saulnier
- Clinical Research Center, Angers University Hospital, Angers, France
| | - P May-Panloup
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P E Bouet
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
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Lefor AK, Harada K, Dosis A, Mitsuishi M. Motion analysis of the JHU-ISI Gesture and Skill Assessment Working Set II: learning curve analysis. Int J Comput Assist Radiol Surg 2021; 16:589-595. [PMID: 33723706 DOI: 10.1007/s11548-021-02339-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE The Johns Hopkins-Intuitive Gesture and Skill Assessment Working Set (JIGSAWS) dataset is used to develop robotic surgery skill assessment tools, but there has been no detailed analysis of this dataset. The aim of this study is to perform a learning curve analysis of the existing JIGSAWS dataset. METHODS Five trials were performed in JIGSAWS by eight participants (four novices, two intermediates and two experts) for three exercises (suturing, knot-tying and needle passing). Global Rating Scores and time, path length and movements were analyzed quantitatively and qualitatively by graphical analysis. RESULTS There are no significant differences in Global Rating Scale scores over time. Time in the suturing exercise and path length in needle passing had significant differences. Other kinematic parameters were not significantly different. Qualitative analysis shows a learning curve only for suturing. Cumulative sum analysis suggests completion of the learning curve for suturing by trial 4. CONCLUSIONS The existing JIGSAWS dataset does not show a quantitative learning curve for Global Rating Scale scores, or most kinematic parameters which may be due in part to the limited size of the dataset. Qualitative analysis shows a learning curve for suturing. Cumulative sum analysis suggests completion of the suturing learning curve by trial 4. An expanded dataset is needed to facilitate subset analyses.
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Affiliation(s)
- Alan Kawarai Lefor
- Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan.
| | - Kanako Harada
- Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
- Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | | | - Mamoru Mitsuishi
- Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
- Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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Seering M, Campos JH. Educational Methods to Improve Thoracic Epidural Block Proficiency for Residents: Video-Based Education Versus Bedside Education. J Cardiothorac Vasc Anesth 2020; 34:3049-3051. [DOI: 10.1053/j.jvca.2020.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/11/2022]
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Gray MM, Edwards EM, Ehret DEY, Brei BK, Greenberg LT, Umoren RA, Ringer S, Horbar J. Resuscitation Opportunities for Fellows of Very Low Birth Weight Infants in the Vermont Oxford Network. Pediatrics 2020; 146:peds.2019-3641. [PMID: 32532791 DOI: 10.1542/peds.2019-3641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neonatal-perinatal medicine (NPM) fellowship programs must provide adequate delivery room (DR) experience to ensure that physicians can independently provide neonatal resuscitation to very low birth weight (VLBW) infants. The availability of learning opportunities is unknown. METHODS The number of VLBW (≤1500 g) and extremely low birth weight (ELBW) (<1000 g) deliveries, uses of continuous positive airway pressure, intubation, chest compressions, and epinephrine over 3 years at accredited civilian NPM fellowship program delivery hospitals were determined from the Vermont Oxford Network from 2012 to 2017. Using Poisson distributions, we estimated the expected probabilities of fellows experiencing a given number of cases over 3 years at each program. RESULTS Of the 94 NPM fellowships, 86 programs with 115 delivery hospitals and 62 699 VLBW deliveries (28 703 ELBW) were included. During a 3-year fellowship, the mean number of deliveries per fellow ranged from 14 to 214 (median: 60) for VLBWs and 7 to 107 (median: 27) for ELBWs. One-half of fellows were expected to see ≤23 ELBW deliveries and 52 VLBW deliveries, 24 instances of continuous positive airway pressure, 23 intubations, 2 instances of chest compressions, and 1 treatment with epinephrine. CONCLUSIONS The number of opportunities available to fellows for managing VLBW and ELBW infants in the DR is highly variable among programs. Fellows' exposure to key, high-risk DR procedures such as cardiopulmonary resuscitation is low at all programs. Fellowship programs should track fellow exposure to neonatal resuscitations in the DR and integrate supplemental learning opportunities. Given the low numbers, the number of new and existing NPM programs should be considered.
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Affiliation(s)
- Megan M Gray
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - Erika M Edwards
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine and.,Vermont Oxford Network, Burlington, Vermont; and.,Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Danielle E Y Ehret
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine and.,Vermont Oxford Network, Burlington, Vermont; and
| | - Brianna K Brei
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Rachel A Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Steven Ringer
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock and Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jeffrey Horbar
- Department of Pediatrics, The Robert Larner, M.D. College of Medicine and.,Vermont Oxford Network, Burlington, Vermont; and
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Weller JM, Naik VN, San Diego RJ. Systematic review and narrative synthesis of competency-based medical education in anaesthesia. Br J Anaesth 2020; 124:748-760. [DOI: 10.1016/j.bja.2019.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/06/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
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Bang S, Chung K, Chung J, Yoo S, Baek S, Lee SM. The erector spinae plane block for effective analgesia after lung lobectomy: Three cases report. Medicine (Baltimore) 2019; 98:e16262. [PMID: 31335674 PMCID: PMC6708622 DOI: 10.1097/md.0000000000016262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique. PATIENT CONCERNS Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted. DIAGNOSES They were diagnosed with primary adenocarcinoma requiring lobectomy of lung. INTERVENTIONS The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later. OUTCOMES The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen. LESSONS Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.
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Affiliation(s)
- Seunguk Bang
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyudon Chung
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyun Chung
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Subin Yoo
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sujin Baek
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Mook Lee
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kwak YL. Redesigning an anesthesiology resident training program to improve practical procedure competency. Korean J Anesthesiol 2017; 70:118-119. [PMID: 28367280 PMCID: PMC5370298 DOI: 10.4097/kjae.2017.70.2.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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