ABSTRACT
BACKGROUND AND OBJECTIVES: Procedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later. METHODS: This prospective comparative study took place in two medical universities. Second-year residents of anesthesiology and intensive care from one region participated in 3h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled-out the same self-assessment form collecting experience with different devices. The control group filled-out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided. RESULTS: 44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406 per resident. CONCLUSIONS: A 3h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation. CLINICALTRIALS. GOV IDENTIFIER: NCT02470195.
Subject(s)
Airway Management/methods , Anesthesiology/education , Internship and Residency , Simulation Training/methods , Adult , Clinical Competence , Critical Care/methods , Educational Measurement , Female , Health Knowledge, Attitudes, Practice , Humans , Intubation, Intratracheal/methods , Male , Prospective StudiesABSTRACT
Abstract Background and objectives Procedural simulation training for difficult airway management offers acquisition opportunities. The hypothesis was that 3 hours of procedural simulation training for difficult airway management improves: acquisition, behavior, and patient outcomes as reported 6 months later. Methods This prospective comparative study took place in two medical universities. Second-year residents of anesthesiology and intensive care from one region participated in 3 h procedural simulation (intervention group). No intervention was scheduled for their peers from the other region (control). Prior to simulation and 6 months later, residents filled-out the same self-assessment form collecting experience with different devices. The control group filled-out the same forms simultaneously. The primary endpoint was the frequency of use of each difficult airway management device within groups at 6 months. Secondary endpoints included modifications of knowledge, skills, and patient outcomes with each device at 6 months. Intervention cost assessment was provided. Results 44 residents were included in the intervention group and 16 in the control group. No significant difference was observed for the primary endpoint. In the intervention group, improvement of knowledge and skills was observed at 6 months for each device, and improvement of patient outcomes was observed with the use of malleable intubation stylet and Eschmann introducer. No such improvement was observed in the control group. Estimated intervention cost was 406€ per resident. Conclusions A 3 h procedural simulation training for difficult airway management did not improve the frequency of use of devices at 6 months by residents. However, other positive effects suggest exploring the best ratio of time/acquisition efficiency with difficult airway management simulation. ClinicalTrials.gov Identifier NCT02470195.
Resumo Justificativa e objetivos O treinamento em simulação para o manejo de via aérea difícil oferece oportunidades de aprendizagem. A hipótese foi que um treinamento em simulação de procedimentos de três horas, para o manejo de via aérea difícil, melhoraria o aprendizado, o comportamento e os resultados dos pacientes, conforme relatado seis meses após o treinamento. Métodos Este estudo comparativo prospectivo foi realizado em duas universidades médicas. Residentes do segundo ano de anestesiologia e terapia intensiva de uma região participaram de um curso de três horas em simulação de procedimentos (grupo intervenção). Nenhuma intervenção foi programada para seus pares da outra região (grupo controle). Antes da simulação e seis meses após, os residentes preencheram a mesma ficha de autoavaliação sobre sua experiência com diferentes dispositivos. O grupo controle preencheu os mesmos formulários simultaneamente. O desfecho primário foi a frequência de uso de cada dispositivo para o manejo de via aérea difícil dentro dos grupos aos seis meses. Os pontos de corte secundários incluíram modificações em relação ao conhecimento, às habilidades e aos resultados dos pacientes com cada dispositivo aos seis meses. A avaliação do custo da intervenção foi registrada. Resultados Foram incluídos no grupo intervenção 44 residentes e 16 no grupo controle. Nenhuma diferença significativa foi observada para o ponto de corte primário. No grupo intervenção, a melhoria do conhecimento e das habilidades foi observada aos seis meses para cada dispositivo e a melhoria dos desfechos dos pacientes foi analisada com o uso de estilete maleável e do introdutor de Eschmann para intubação. Nenhuma melhoria foi observada no grupo controle. O custo da intervenção estimado foi de 406€ por residente. Conclusões Um treinamento simulado de três horas para o manejo de via aérea difícil não melhorou a frequência do uso de dispositivos pelos residentes aos seis meses. No entanto, outros efeitos positivos sugerem a exploração da melhor relação tempo/eficiência de aquisição de conhecimento com a simulação do manejo de via aérea difícil. ClinicalTrials.gov Identifier NCT02470195.
Subject(s)
Humans , Male , Female , Adult , Airway Management/methods , Simulation Training/methods , Internship and Residency , Anesthesiology/education , Health Knowledge, Attitudes, Practice , Prospective Studies , Clinical Competence , Critical Care/methods , Educational Measurement , Intubation, Intratracheal/methodsABSTRACT
Excessive consumption of industrialized food and beverages is a major etiologic factor in the epidemics of obesity and associated metabolic diseases because these products are rich in fat and sugar. In addition, they contain food contact materials and environmental pollutants identified as metabolism disrupting chemicals. To evaluate the metabolic impact of these dietary threats (individually or combined), we used a male mouse model of chronic exposure to a mixture of low-dose archetypal food-contaminating chemicals that was added in standard or high-fat, high-sucrose (HFHS) diet. Specifically, the mixture contained bisphenol A, diethylhexylphthalate, 2,3,7,8-tetrachlorodibenzo-p-dioxine and polychlorinated biphenyl 153. Exposure lasted from 5 to 20 weeks of age. Metabolic exploration was conducted setting the basis of candidate gene expression mRNA analyses in liver, jejunum and adipose tissue depots from 20 week-old mice. Strong metabolic deleterious effects of the HFHS diet were demonstrated in line with obesity-associated metabolic features and insulin resistance. Pollutant exposure resulted in significant changes on plasma triglyceride levels and on the expression levels of genes mainly encoding xenobiotic processing in jejunum; estrogen receptors, regulators of lipoprotein lipase and inflammatory markers in jejunum and adipose tissues as well as adipogenesis markers. Importantly, the impact of pollutants was principally evidenced under standard diet. In addition, depending on nutritional conditions and on the metabolic tissue considered, the impact of pollutants could mimic or oppose the HFHS effects. Collectively, the present study extends the cocktail effect concept of a low-dosed pollutant mixture and originally points to tissue-specificity responsiveness especially in jejunum and adipose tissues.
