The ZADP and the Zambia Master of Medicine (MMed) Anaesthesia programme provides an example of a cross-cultural peer-directed co-learning model that benefits trainees from developed and developing postgraduate training programmes. This synergistic model is one that could be applied to other educational initiatives supported from overseas. This model not only adds a useful dimension to the educational support provided, but also embodies the principle of co-development that is so important to the sustainability of such projects.
Background: Pediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact. Aim:The aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period. Methods: A survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 -October 13, 2020.Results: Sixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations. Conclusion:Our data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated. | 721 SONERU Et al.
Introduction: Cricothyrotomy is the final option in all cannot-ventilate non-intubate airway-management algorithms. A decline in the need for cricothyrotomies has resulted in decreased exposure of physicians to this life saving technique. Although 80% of American anesthesiology residency programs teach cricothyrotomy, 60% consist of lectures only. Consequently, residents, often the first physicians on scene during resuscitations, have very little experience or confidence to perform this emergent intervention. This study compared cricothyrotomy skills acquired on a simple inexpensive model vs. a high fidelity simulator using valid evaluation instruments. We tested the transfer of these skills to human cadavers using global assessment scales (GRS), task specific checklists (CL), and procedure time. Methods: After REB approval, 22 first and second year anesthesiology residents were recruited. All subjects performed a pre-test cricothyrotomy on embalmed adult human cadavers. Cadaver exclusion criteria consisted of previous neck surgery/disease and a BMI>35. The pretest sessions were videotaped in a manner masking the residents' identity and level of training. Correct placement of the tube was confirmed by dissection. Subjects then watched an instructional video followed by didactic instruction and were randomized into 2 groups: High Fidelity (HF, n=11) training on a full-scale Laerdal SimMan® simulator possessing an anatomically accurate larynx a and Low Fidelity (LF, n=11) training on a model constructed from corrugated tubing. All subjects performed 2 supervised cricothyrotomies on their designated model. Within 2 weeks of the training session all subjects performed a videotaped cricothyrotomy post-test on a cadaver. Two blinded examiners timed and graded the performances using a 3-point CL and GRS. Results: There was no significant difference in cricothyrotomy performance between the LF and HF model groups as evaluated by CL, GRS, and time (all:p=NS). Training on a model significantly improved cricothyrotomy performance irrespective of fidelity when evaluated by CL, GRS, and time (all: p<0.001). Inter-rater reliability was strong (checklist: r=0.90; GRS: r=0.89).
BackgroundThe burden of treatable surgical diseases in children in low- and middle-income countries (LMICs) is greater than that of malaria, HIV/AIDS and TB combined. World Health Organisation member states are required to scale up access to emergency and essential surgery for children by 2030 as part of universal health coverage. There is a critical shortage of anaesthetists trained to look after children in LMICs. The aim of this project was to deliver the Safer Anaesthesia From Education (SAFE) Paediatric course in East and Central Africa, and to evaluate the impact of this training programme.MethodsThe SAFE Paediatric anaesthesia course is a three-day short course developed by GOSH paediatric anaesthetists in collaboration with the Association of Anaesthetists of Great Britain and Ireland (AAGBI), World Federation of Societies of Anaesthesiologists (WFSA) and Association of Anaesthesiologists of Uganda (AAU). It focuses on common paediatric surgical conditions encountered in LMICs. A one-day Train-The-Trainer (TTT) course was also established to train future SAFE faculty.ResultsA total of nine SAFE courses were delivered. ‘SAFE fellows’ conducted follow-up interviews in Uganda, Zambia and Malawi. 46/57 (81%) faculty members who completed the TTT course taught on a subsequent SAFE course. 381 delegates completed the course. Mean MCQ scores increased from 37.6/50 pre-course to 43.4/50 post-course and skills scores increased from 5.8/10 to 8/10 (p<0.001).Follow-up showed significantly higher mean MCQ (pre-course 37.6/50, follow-up 41.5/50) and skills test scores (pre-course(5.8/10), follow-up(8.2/10)). All interviewed delegates reported increased confidence in providing paediatric anaesthesia.ConclusionThe SAFE paediatric anaesthesia course provides high quality education for anaesthetists in LMICs. Knowledge and skills improve and are retained at follow-up. SAFE course training results in changes in paediatric anaesthesia practice and improved patient outcomes. Delivery of the SAFE training through UK/LMIC anaesthesia health partnerships builds links between paediatric anaesthetists internationally.
The mean age was 28 yr. The majority of patients, 64/69 (93%), were male. By mechanism of injury, 55 (80%) were assaulted, there were five sports injuries (7%), four road traffic accidents (6%), four trips/falls (6%), and one case where the mechanism was unclear. Fifty-seven patients (83%) suffered isolated injuries; 12 (17%) sustained concomitant injuries, although none required any other operative intervention. No patients suffered a C-spine injury. The most widely used 'primary' laryngoscopy strategy, in 43 cases (62%), was video laryngoscope (C-MAC®, Karl Storz GmbH & Co. KG (Tuttlingen, Germany) in our centre). Direct laryngoscopy with a Macintosh blade was performed in 20 cases (29%). Six cases (9%) were intubated electively with a fibreoptic scope (four awake and two asleep), although the reasons for this choice of technique were not clear. Mouth opening was quantitatively recorded in all 69 cases. There was no intubation difficulty in any of the 69 cases, and none required a 'secondary' intubation strategy. This cohort, most of whom presented with an isolated injury, represents a subset of patients with mandibular fractures. Polytrauma patients are managed at our regional trauma centre. No patients sustained C-spine injuries, similar to a previously published work, 1 showing that isolated mandibular fractures are rarely associated with C-spine injury. Despite the typical presentation with significant trismus, and despite 26% of patients having a condylar fracture, which can be associated with mechanical obstruction to mouth opening, 2 the vast majority of patients in this cohort (91%) were intubated uneventfully using either a videolaryngoscope or a standard Macintosh blade.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.