ABSTRACT
INTRODUCTION: Lumbar puncture (LP) is a common invasive technique considered an essential learning milestone for anesthesiologists due to its application in spinal anesthesia. We aimed to develop an in-house LP simulator, test its effectiveness in learning the steps to perform an LP and analyze its impact on the first-year residents' self-confidence at our hospital. METHODS: We used 3D printing and silicone casting to create an LP simulator based on a lumbar spine computed tomography (CT). We divided 12 first-year anesthesiology residents into control and experimental groups. The control group received traditional training, while the experimental group practiced with the simulator for three months. We used a procedure checklist and a Likert scale survey to evaluate their procedural knowledge and self-confidence at baseline, three, and six months. Eighteen months later, we evaluated their LP performance skills. RESULTS: Both groups showed a significant improvement in their knowledge scores over time. After three months, the experimental group had a higher median knowledge score (10 (10 - 10) median (min-max)) than the control group (9 (8 - 9.5) median (min-max)) (p = 0.03). While there were no apparent differences in median self-confidence scores between the groups at any time point, the experimental group had a significant increase in their self-confidence for performing an unassisted LP, with a median score of 1/5 (1 - 2.3) at baseline and 5/5 (4.8 - 5) after six months (p = 0.006). In contrast, the control group's self-confidence scores decreased from 4/5 (3 - 4) after three months to 3/5 (2 - 5) after six months. The evaluation of performance skills did not yield statistically significant results. CONCLUSION: Our study demonstrates that an in-house LP simulator is an effective and practical approach for first-year anesthesiology residents to learn the LP procedure. This approach could be particularly useful in settings with limited resources and a lack of sufficient patients to practice on, as it provides an opportunity for faster learning and increased self-confidence.
ABSTRACT
ANTECEDENTES: Una de las principales complicaciones de la diabetes mellitus es la amputación de alguna extremidad. En todo el mundo, la prevalencia de amputaciones asociadas a la diabetes es muy variada y tiene un impacto considerable en la calidad de vida del paciente. OBJETIVO: Analizar la frecuencia de las amputaciones en el Hospital Universitario Dr. José E. González y evaluar si se presenta un patrón estacional. MÉTODO: Se realizó un estudio retrospectivo de 2009 a 2012, en el que se revisaron los expedientes de pacientes diabéticos que se sometieron a amputación. La estacionalidad se analizó con la bondad de ajuste de ji al cuadrado. RESULTADOS: Se analizaron 456 amputaciones. Los resultados muestran que febrero es el mes que presenta la mayor frecuencia de amputaciones. La estación anual con mayor número de amputaciones fue el invierno. CONCLUSIONES: Las amputaciones en pacientes diabéticos del área metropolitana de Monterrey presentan un patrón estacional, siendo los meses de invierno los de mayor frecuencia. BACKGROUND: The amputation of an extremity is a main complication of Diabetes mellitus. Worldwide the prevalence of amputations associated with diabetes mellitus is variable and had a considerable impact in the quality of life. OBJECTIVE: Analyze the frequency of amputations in the University Hospital, Dr José E González and evaluate if a seasonal pattern is present. METHOD: A retrospective analysis from 2009 to 2012 was carried out. Clinical files of diabetic patients undergoing to amputation were studied. The seasonality was evaluated with a chi square goodness of fit. RESULTS: A total of 456 amputations were studied. Results shown that February was the month with highest frequency of amputations while winter was the annual season with highest frequency of amputations. CONCLUSIONS: Amputations of diabetic patients from Metropolitan Monterrey Mexico show a seasonal pattern being the winter months those that present highest frequency.
