Purpose: Communication skills education is still relatively new in some non-Western countries. Further, most evaluation research on communication skills education examines only short-term results. In our communication skills program in Qatar, we aimed to: 1) assess the impact of the communication skills course on participant skills application; 2) assess the length of time since course completion associated with participant skills application; and 3) assess participant gender or clinical position associated with participant skills application. Methods: Seven hundred and thirty-eight physicians completed a seven-module communication skills course. Participants reflected on what they learned in the course and how the course had impacted their behavior through a nine-item online survey that included a fouritem Communication Workshop Impact Scale (CWIS), three open questions, and two demographic questions. To assess the effect of time since workshop on outcomes, we stratified the respondents into five groups based on how long ago they had completed the course. Results: Three hundred and thirty-two physicians completed the survey. Participants reported agreement with the items on the CWIS: X=4.45 (range 1-5; SD=0.70). When asked which skill(s) they had been able to implement in their clinical practice, 235 gave a specific response, either a specific communication skill (eg, ask open questions), a higherorder category of skills (eg, questioning skills), or the name of one of the seven modules of the course. Only 28 participants listed the name of a skill or module name that they had not been able to implement. There was no evidence of difference in CWIS score based on time since course completion. There was no gender difference; however, residents had significantly lower CWIS scores than fellows (4.70 vs. 4.29, p<0.05). Conclusion: Participants reported agreement with response items about the impact of the course on their skills application. Participant gender did not play a significant role, but residents had lower scores than did fellows. Furthermore, most physicians (92%) were able to name something specific that they had learned from the course and were currently implementing in their practice. Positive outcomes of the course did not seem to diminish over time. Future research should identify whether observable communication behavior matches the self-reported behavior.
Acute hyperventilation leading to hypocalcaemia during spinal anaesthesiahis chest was clear. Trousseau's sign 2 was noticed on the left hand, where the sphygmomanometer cuff was placed and inflated for measurement. A blood sample for the measurement of ionized calcium and blood gases was drawn. An infusion of 20 ml of 10 percent calcium gluconate in 100ml of 5% dextrose was given over 20 minutes. The Trousseau sign disappeared five minutes after calcium administration and patient improved symptomatically. After 20 minutes, a second infusion of calcium gluconate was begun and surgery was completed without further complication.The patient was transferred to the recovery room in a fully conscious and haemodynamically stable state while receiving the calcium gluconate infusion. The intraoperative ECG did not show a prolonged QT interval. The intraoperative ionized calcium level was low (0.6mmol/L) and blood gases showed a respiratory alkalosis (PaO 2 =160mmHg, PaCO 2 =22mmHg (2.9kPa, pH =7.57 and HCO 3 =18mmol/l). Subsequent calcium concentrations were within the normal range. An endocrinologist was consulted, who did not detect a pathological cause for the episode of hypocalcaemia. DiscussionThe most common cause of decreased total serum calcium is hypoalbuminaemia. 1 This is artifactual as ionized calcium remains normal. The ionized calcium may be roughly estimated by the following formula. Corrected calcium (mmol/L) = Serum calcium (mmol/L) + 0.8 [4-Serum albumin (gm/dl)]. Ionized calcium should be measured whenever true hypocalcaemia is suspected. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionized calcium. An increase from a pH of 7.4 to 7.6 may decrease ionized calcium by 0.25 mmol/L and precipitate tetany.Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionized hypocalcaemia 1 , and this appears to be the case in the operating room. 3 However, it has not been reported during spinal anaesthesia. Many patients complain of difficulty in breathing following spinal anaesthesia probably because of loss of proprioceptive sensation from intercostal and abdominal muscles. IntroductionHypocalcaemia during anaesthesia is a rare entity. Acute onset hypocalcaemia has variable presentations, many of which can be life threatening. The signs and symptoms of hypocalcaemia are characteristic 1 , thus can be treated in emergency conditions without waiting for the result of ionized serum calcium measurement. We present a case in which the patient developed hypocalcaemia under spinal anaesthesia.
Hypotension and bradycardia after application of suction to a subgaleal drain, or stimulus inside or outside the skull, have been reported in the medical literature. The commonly reported occurrence is stimulation of the Trigeminal nerve along its distribution and is the main factor that sets off the whole reflex arc through the Vagus nerve ending in a series of serious hemodynamic changes that institute severe bradycardia, asystole and severe hypotension. Another less common but possible patho logy caused by a suction drain is Pseudo-Hypoxic Brain Swelling (PHBS). We report a case of transient cardiac arrest after the application of theatre suction to a subgaleal drain at the closure of an uneventful craniotomy and discuss the possibilities as well as review the literature.
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