Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition.

OBJECTIVES: This study compared the effectiveness of a multimedia ultrasound (US) simulator to normal human models during the practical portion of a course designed to teach the skills of both image acquisition and image interpretation for the Focused Assessment with Sonography for Trauma (FAST) exam. METHODS: This was a prospective, blinded, controlled education study using medical students as an US-naïve population. After a standardized didactic lecture on the FAST exam, trainees were separated into two groups to practice image acquisition on either a multimedia simulator or a normal human model. Four outcome measures were then assessed: image interpretation of prerecorded FAST exams, adequacy of image acquisition on a standardized normal patient, perceived confidence of image adequacy, and time to image acquisition. RESULTS: Ninety-two students were enrolled and separated into two groups, a multimedia simulator group (n = 44), and a human model group (n = 48). Bonferroni adjustment factor determined the level of significance to be p = 0.0125. There was no difference between those trained on the multimedia simulator and those trained on a human model in image interpretation (median 80 of 100 points, interquartile range [IQR] 71-87, vs. median 78, IQR 62-86; p = 0.16), image acquisition (median 18 of 24 points, IQR 12-18 points, vs. median 16, IQR 14-20; p = 0.95), trainee's confidence in obtaining images on a 1-10 visual analog scale (median 5, IQR 4.1-6.5, vs. median 5, IQR 3.7-6.0; p = 0.36), or time to acquire images (median 3.8 minutes, IQR 2.7-5.4 minutes, vs. median = 4.5 minutes, IQR = 3.4-5.9 minutes; p = 0.044). CONCLUSIONS: There was no difference in teaching the skills of image acquisition and interpretation to novice FAST examiners using the multimedia simulator or normal human models. These data suggest that practical image acquisition skills learned during simulated training can be directly applied to human models.

Evaluating infant positioning for lumbar puncture using sonographic measurements.

OBJECTIVES: Hypoxia has been observed when infants undergo lumbar puncture in a tight flexed lateral recumbent position. This study used sonographic measurements of lumbar interspinous spaces to investigate the anatomic necessity and advantage derived from this tight flexed positioning in infants. METHODS: This was a brief, prospective, observational study of a convenience sample of patients. Twenty-one healthy infants under 1 month of age were scanned in two positions: prone in a spine-neutral position and lateral recumbent with their knees bent into their chest and their neck flexed. In each position, a 5- to 10-MHz linear array transducer was used to scan midline along the lumbar spinous processes in the sagittal plane. The distances between the spinous processes were measured near the ligamentum flavum using the ultrasound machine's calipers. Pulse oximetry was monitored on all infants during flexed positioning. RESULTS: In the spine-neutral position, all studied interspinous spaces were much wider than a 22-gauge spinal needle (diameter 0.072 cm). The mean (±SD) interspinous spaces for L3-4, L4-5, and L5-S1 in a spine-neutral position were 0.42 (±0.07), 0.37 (±0.06), and 0.36 (±0.11) cm, respectively. Flexing the infants increased the mean lumbar interspinous spaces at L3-4, L4-5, and L5-S1 by 31, 51, and 44%, respectively. CONCLUSIONS: This study verified that tight, lateral flexed positioning substantially enhances the space between the lumbar spinous processes and that a spine-neutral position also allows for a large enough anatomic interspinous space to perform lumbar puncture. However, further clinical research is required to establish the feasibility of lumbar puncture in a spine-neutral position.

Adrenal gland differences associated with puberty and reproductive inhibition in Peromyscus maniculatus.

Laboratory populations of the prairie deermouse (Peromyscus maniculatus) reach a growth asymptote due primarily to the failure of more than 90% of the young born into the population to mature sexually. This inhibition is reversible; when young are removed from the inhibiting influence of the population more than 75% will reproduce within 80 days of pairing. Interestingly, the mechanism of this inhibition does not involve the degree of adrenal hypertrophy as reported in rats and housemice. We report here that the adrenal morphology of reproductively inhibited deermice raised within laboratory populations is different from patterns seen with normal puberty; namely in the area, histology, and apparent activity of the weak androgen-secreting zona reticularis. Our data indicate that the frequency of adrenal cortex cellular apoptosis is not different between the adrenal zones or between reproductively capable versus inhibited animals and therefore does not account for the differences in the numbers of cells with pycnotic nuclei in the zona reticularis of inhibited animals. We also found that the concentration of serum DHEA is significantly reduced in reproductively inhibited animals suggesting that the zona reticularis of inhibited animals may be less active than in controls. We present data to indicate that the adrenal zona reticularis of 30-day-old control animals is likely to be more active than reproductively inhibited animals of the same age. Our data also indicate that older reproductively inhibited animals of both sexes are also likely to have a much less active zona reticularis. These differences may be implicated in the mechanism of reproductive inhibition.