Examining novice anaesthesia trainee simulation performance: a tale of two clusters.

Introduction: Understanding performance differences between learners may provide useful context for optimising medical education. This pilot study aimed to explore a technique to contextualise performance differences through retrospective secondary analyses of two randomised controlled simulation studies. One study focused on speaking up (non-technical skill); the other focused on oxygen desaturation management (technical skill).

Resident Preparation for the American Board of Anesthesiology Objective Standardized Clinical Examination: A Comparison of Virtual Telesimulation With In-person Simulation.

Background: The Objective Structured Clinical Examination (OSCE) is part of the American Board of Anesthesiology (ABA) certification process. A simulated OSCE can aid examination preparation, but the COVID-19 pandemic prevented in-person simulation training. Therefore, we adapted our in-person simulated OSCE (SOSCE) as a Zoom-based telesimulation OSCE (ZOSCE), permitting examinees to participate remotely.

Novel intraoperative online functional mapping of somatosensory finger representations for targeted stimulating electrode placement: technical note.

Defining eloquent cortex intraoperatively, traditionally performed by neurosurgeons to preserve patient function, can now help target electrode implantation for restoring function. Brain-machine interfaces (BMIs) have the potential to restore upper-limb motor control to paralyzed patients but require accurate placement of recording and stimulating electrodes to enable functional control of a prosthetic limb. Beyond motor decoding from recording arrays, precise placement of stimulating electrodes in cortical areas associated with finger and fingertip sensations allows for the delivery of sensory feedback that could improve dexterous control of prosthetic hands.

Anesthesia Simulation Boot Camp-a Decade of Experience Enhancing Self-efficacy in First-year Residents.

Background: Novice anesthesiology residents must acquire new technical, cognitive, and behavioral skills as they transition into the high-stakes perioperative environment. Simulation-based education improves procedural skill and behavior, and it permits deliberate practice with feedback; exposure to uncommon, high-consequence events; assessment; reproducibility; and zero risk to patients. We introduced a 5-day, high-fidelity Simulation Boot Camp (SBC) in 2006 for first-year clinical anesthesia residents (CA-1s) and report over a decade of experience assessing its impact on self-efficacy, value, feasibility, and sustainability.

Evaluation of 3 Cognitive Load Measures During Repeated Simulation Exercises for Novice Anesthesiology Residents.

Introduction: Maintaining an appropriate level of cognitive load during simulations is crucial to optimize learning. We evaluated 3 subjective measures of cognitive load in a simulated operating room (OR) context across multiple scenarios of varying complexity.

Methods: This observational study of 25 first-year anesthesiology residents took place during a 5-day simulation "Boot Camp.

The sim must go on: adapting resident education to the COVID-19 pandemic using telesimulation.

The COVID-19 pandemic and social distancing rules necessitated the suspension of all in-person learning activities at our institution. Consequently, distance learning became essential. We adapted a high-fidelity immersive case-based simulation scenario for telesimulation by using the virtual meeting platform Zoom® to meet our curricular needs.

Factors that influence flow through intravascular catheters: the clinical relevance of Poiseuille's law.

Background: The physics of ideal fluid flow is well characterized. However, the effect of catheter size, tubing types, injection port adjuncts, and viscosity on flow is not well described. We used a simulated environment to determine how various permutations of common elements affect fluid flow.

Development of a Simulated Objective Structured Clinical Exam for the APPLIED Certification Exam in Anesthesiology: A Two-Year Experience Informed by Feedback from Exam Candidates.

Background: Program directors of anesthesiology residencies agree that it is the program's responsibility to prepare residents for primary American Board of Anesthesiology (ABA) certification, although few report an Objective Standardized Clinical Exam (OSCE) program reflective of the new ABA examination. We created an authentic simulated OSCE (SOSCE) using existing resources to prepare third-year clinical anesthesia residents for the ABA APPLIED exam before graduation and identify knowledge gaps relevant to the OSCE.

Methods: Junior anesthesiology residents and medical students acted as standardized patients for the 7 SOSCE stations.

Efficacy and Cost Comparison of Case-based Learning to Simulation-based Learning for Teaching Malignant Hyperthermia Concepts to Anesthesiology Residents.

Background: Case-based learning (CBL) is a distinct classroom-based teaching format. We compare learning and retention using a CBL teaching strategy vs simulation-based learning (SBL) on the topic of malignant hyperthermia.

Methods: In this study, 54 anesthesia residents were assigned to either a CBL or SBL experience.

Training novice anaesthesiology trainees to speak up for patient safety.

Background: Effectively communicating patient safety concerns in the operating theatre is crucial, but novice trainees often struggle to develop effective speaking up behaviour. Our primary objective was to test whether repeated simulation-based practice helps trainees speak up about patient management concerns. We also tested the effect of an additional didactic intervention over standard simulation education.

Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability.

Primary Objective: The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality.

Design And Methods: Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert-Huang method in the spectral range 0.

Influence of Heart Rate, Age, and Gender on Heart Rate Variability in Adolescents and Young Adults.

Key autonomic functions are in continuous development during adolescence which can be assessed using the heart rate variability (HRV). However, the influence of different demographic and physiological factors on HRV indices has not been fully explored in adolescents. In this study we aimed to assess the effect of age, gender, and heart rate on HRV indices in two age groups of healthy adolescents (age ranges, 13-16 and 17-20 years) and two groups of healthy young adults (21-24 and 25-30 years).

Use of intraosseous hypertonic saline in critically ill patients.

Background: Rapid administration of hypertonic saline 23.4% is crucial in treatment of herniation syndromes. Hypertonic 23.

Multidisciplinary Difficult Airway Course: An Essential Educational Component of a Hospital-Wide Difficult Airway Response Program.

Objective: A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC).

Design: The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management.

Very High Frequency Oscillations of Heart Rate Variability in Healthy Humans and in Patients with Cardiovascular Autonomic Neuropathy.

Literature reports on the very high frequency (VHF) range of 0.4-0.9 Hz in heart rate variability (HRV) are scanty.

Predicting the need for nonstandard tracheostomy tubes in critically ill patients.

Purpose: Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway.

Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

Background: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging.

Methods: We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room.

Residual vasomotor activity assessed by heart rate variability in a brain-dead case.

A patient assessed by heart rate variability (HRV) methodology, beginning just after the completion of brain death (BD) diagnosis, showed remaining very low frequency (VLF) waves for approximately 10 min. A time-varying spectral analysis showed that during the first 550 s, a significant power spectral density remained in the high-frequency (HF), low-frequency (LF) and VLF bands. From 550 to 675 s, the HF oscillations totally vanished, and a marked progressive decay of the LF and VLF power density occurred.

Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma.

Background: Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines.

Methods: We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis.

Results: A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma.

Exploring quality of life in critically ill tracheostomy patients: a pilot study.

Background: Tracheostomies are performed to improve health-related quality of life (QOL) in patients requiring prolonged mechanical ventilation. As the lengths of stay in intensive care units (ICU) increase and higher rates of tracheostomies are becoming more prevalent, issues regarding patient perceptions of their own prognoses and outcomes after tracheostomy can considerably impact QOL and in turn their care and recovery. Whether tracheostomy improves QOL, however, has not been studied adequately.

Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety.

Objectives/hypothesis: To develop and assess the feasibility of a new standardized protocol to guide tracheostomy decannulation.

Study Design: Descriptive review of quality improvement project.

Methods: A quality improvement project was conducted in the inpatient setting of a tertiary urban academic hospital.

Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment.

Objective: To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records.

Methods: We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days.

Safety and efficiency of interventional pulmonologists performing percutaneous tracheostomy.

Background: The steady rise in the number of critically ill patients in the USA has led to an increase in the need for tracheostomies in patients requiring chronic ventilatory support. There is a matched need for experienced operators to safely and efficiently perform these procedures.

Objectives: We evaluated the effects on procedural outcomes and efficiency of percutaneous dilatational tracheostomy (PDT) placement in the medical intensive care unit (MICU) by the surgical team (ST) or interventional pulmonologists (IP).