Background In this study, we describe a custom-made new epidural simulator, created by modifying the inner structure of a commercially available one, in the attempt to make it adequately realistic. To validate and evaluate the realism of our device, we used the Computerized Epidural Instrument CompuFlo. Method The Compuflo CompuFlo curves obtained from 64 experiments on the epidural simulator were compared to 64 curves obtained from a previous human study, from consecutive laboring parturients requesting epidural analgesia. Results Epidural simulator and human pressure curves were very similar. There was a significant difference between the drop of pressure due to false and true loss of resistance (LOR) in both the groups. Discussion Our simulator can realistically reproduce the anatomical layers the needle must pass as demonstrated by the similarity between the simulator and human pressure curves and the small differences of pressure values recorded. CompuFlo may be used as an objective tool to create and assess and compare objectively the epidural task trainers.

Background: FantaTraining® is an app that simulates a football league. Each participant represents a team, and the game is played with the opposing team by answering a questionnaire. In the intervals between games, participants can practice by consulting the educational material (films, short texts, or slides) in the app. Various prizes are offered to the winners of the championship. In this study, we aimed to evaluate whether the use of the FantaTraining® app could improve the learning of anesthesia trainees registered in an online obstetric anesthesia course. Methods: The study involved 282 trainees in anesthesia, from five Italian universities, registered in the Online Obstetric Anesthesia Course (OOAC) who were given the app. They were randomly allocated into two groups according to whether the app had been enabled to allow the participant to play the league (study group, n=137), or not (control group, n=145). All the trainees underwent entry and final tests, consisting of the same 40 multiple choice questions, respectively before and after completing the OOAC course. Results: There were no differences in the scores obtained in the pre-course test between the groups. The mean score obtained in the final test was significantly greater than that obtained in the entry one in both groups (P<0.05) but the final test score obtained by the participants of the study group was significantly greater than that obtained by the control group. (P<0.001), regardless of the university of origin and year of specialization. Trainees stated that the app had helped their study, improving understanding and motivation, without increasing the intensity of study. Conclusions: Using the FantaTraining® app greatly improved trainees’ final exam performance after the online obstetric anesthesia course. The FantaTraining® app seems a promising tool to improve learning outcomes by strengthening learning behaviors and attitudes towards learning.

The ability of recognizing the ligamentum flavum is the first, crucial, important skill to teach novices when they are learning the epidural technique. The aim of this preliminary prospective study was to evaluate whether the Compuflo® Epidural instrument may help inexperienced trainees to better identify the ligamentum flavum during an epidural simulator training session. Compuflo® reduced the total number of attempts to identify the ligamentum flavum and increased three fold the chance to identify it at the first attempt during a simulator-assisted training module, making this identification easier for inexperienced trainees. This trial is registered with NCT03812926.

Background The use of eye tracking in the simulated setting can help improve our understanding of what sources of information clinicians are using as they deliver routine patient care. The aim of this simulation study was to observe the differences, if any, between the eye tracking patterns of leaders who performed best in a simulated postpartum hemorrhage (PPH) high-fidelity scenario, in comparison with those who performed worst. Methods Forty anesthesia trainees from the University of Catania Medical School were divided into eight teams, to enact four times the same scenario of a patient with postpartum hemorrhage following vaginal delivery. Trainees who were assigned the leader’s role wore the eye tracking glasses during the scenario, and their behavioral skills were evaluated by two observers, who reviewed the video recordings of the scenarios using a standardized checklist. The leader’s eye tracking metrics, extracted from 27 selected areas of interest (AOI), were recorded by a Tobii Pro Glasses 50 Hz wearable wireless eye tracker. Team performance was evaluated using a PPH checklist. After completion of the study, the leaders were divided into two groups, based on the scores they had received (High-Performance Leader group, HPL, and Low-Performance Leader group, LPL). Results In the HPL group, the duration and number of fixations were greater, and the distribution of gaze was uniformly distributed among the various members of the team as compared with the LPL group (with the exception of the participant who performed the role of the obstetrician). The HPL group also looked both at the patient’s face and established eye contact with their team members more often and for longer (P < .05). The team performance (PPH checklist) score was greater in the HPL group (P < .001). The LPL group had more and/or longer fixations of technical areas of interest (P < .05). Conclusions Our findings suggest that the leaders who perform the best distribute their gaze across all members of their team and establish direct eye contact. They also look longer at the patient’s face and dwell less on areas that are more relevant to technical skills. In addition, the teams led by these best performing leaders fulfilled their clinical task better. The information provided by the eye behaviors of “better-performing physicians” may lay the foundation for the future development of both the assessment process and the educational tools used in simulation. Trial Registration Clinical.Trial.Gov ID n. NCT04395963.

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BACKGROUND: Traditional hormone therapy (HT) is effective for managing menopausal symptoms. Although controversial, HT may also have cardioprotective effects, such as improving endothelial function. However, HT usage plummeted following the Women’s Health Initiative. A popular therapeutic option that has emerged as an alternative is bioidentical hormone therapy (bioHT). Although popular for its claim of being a natural therapy, the effects of bioHT on the cardiovascular system, specifically endothelial function and blood pressure, are not well established in menopausal women. PURPOSE: To test the hypothesis that 5 weeks of bioHT will improve endothelial function and blood pressure in menopausal women. METHODS: Women were recruited from the local community and clinics offering bioHT. Women seeking bioHT completed baseline testing (pre) within seven days of pellet insertion, and again after 5 weeks of treatment (post). Control women were not using any form of hormones, and measured at their convenience 5 weeks apart. Endothelial function was measured using brachial artery flow mediated dilation (FMD). Resting brachial blood pressure was recorded in triplicate in the supine position using an automated sphygmomanometer (Dinamap Dash 2000). Comparisons were made using two-way repeated measures ANOVA. RESULTS: Eleven women completed the study: 4 bioHT (57 ± 5 yrs) and 7 Control (54+4 yrs). Women were well matched for body mass index (bioHT: 25+3 kg/m2; control: 24+3 kg/m2; p=0.75), total cholesterol (bioHT: 213+71mg/dL; control 206+46mg/dL, p=0.84), and fasting plasma glucose (bioHT: 89+6mg/dL; control 90+13mg/dL, p=0.83). After 5 weeks, FMD did not change in bioHT (pre: 4.89% ± .8; post: 5.76% ± 2.2) or control women (pre: 3.73% ± 1.3; post: 4.18% ± 1.7; p>0.10). Resting systolic blood pressure was also not different after 5 weeks in bioHT (pre: 132 ± 20mmHg, post: 126 ± 17mmHg) or control women (pre: 113 ± 5mmHg, post: 110 ± 9mmHg; p>0.05). However, resting diastolic blood pressure tended to decrease in bioHT (pre: 79 ± 12mmHg, post: 72 ± 11mmHg; p=0.08) but not control women (pre: 71 ± 5 mmHg, post: 70 ± 7mmHg; p=0.52). CONCLUSION: These preliminary findings suggest that 5 weeks of bioHT does not negatively impact endothelial function, and may lower resting blood pressure. Additional data are needed to further assess the implications of bioHT on the cardiovascular system. Supported by NIH R01 HL 146558 and P20 GM113125 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

BACKGROUND Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance. OBJECTIVE The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator. METHODS We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure. Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded. RESULTS The duration of the epidural procedure was shorter and the number of epidural attempts reduced after the tutorial. Before the tutorial, during needle insertion. the eye tracking metrics showed more visit counts of shorter duration and after the tutorial less visit counts (P=.05) but of longer duration (P=.03). A significant correlation was observed between the number of epidural needle insertions (additional attempts) and the number (OR=2.02 (0.23-1.27; P=.008)) and duration (OR=0.65 (-0.93-0.02; P=.05)) of visits. CONCLUSIONS In novice anesthesia trainees who had never previously performed an epidural block, we observed significant changes in gaze behavior associated with increased performance during the initial phase of epidural technique learning with a simulator. These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation. CLINICALTRIAL Not necessary

Endothelin‐1 (ET‐1) is a vasoconstrictor that acts on the vasculature through ETA and ETB receptors. Both ETA and ETB receptors are located in the skin and are involved in regulating skin blood flow. ETB receptors are also located on axon terminals on c‐type nociceptor fibers. Rapid local heating stimulates the axon reflex which has been established as a mediator of the initial vasodilation response. Although ETA receptors have been shown to augment the axon reflex resulting in a vasodilation, less is known about the role of the ETB receptors on the axon reflex. Purpose The purpose of this study was to determine the contribution of ETB receptors to the axon reflex response. Methods We retrospectively analyzed data in 24 healthy young women (27±10 yrs). Cutaneous vasodilatory responses to local heating were measured using laser doppler flowmetry during microdialysis perfusions of lactated Ringer's (control) and ETB receptor blockade (BQ‐788, 300nM). Cutaneous vascular conductance (CVC) was calculated during the initial peak and nadir of the axon reflex during local heating (42°C), and normalized to maximal vasodilation achieved by perfusion of sodium nitroprusside (28mM) and heating to 43°C. We used paired samples t‐tests to analyze differences in vasodilation between control and ETB receptor blockade sites. Results All subjects were normotensive (MAP: 83±8 mmHg) and had a normal BMI (23±3 kg/m2). There were no significant differences in skin blood flow between control and ETB receptor blockade sites during initial peak (control: 63 ±15; ETB receptor blockade: 62±17 %CVC max, P=0.70) or nadir (control: 52±16; ETB receptor blockade: 50±18 %CVC max, P=0.49). There was also no significant difference between conditions in time to initial peak (control: 142±75; ETB receptor blockade: 140±53 s, P=0.79). Conclusions These preliminary findings suggest ETB receptors do not impact axon reflex mediated vasodilation during local heating in healthy young women. Future research is needed to understand the mechanisms contributing to the axon reflex to regulate blood flow in the cutaneous circulation.