ABSTRACT
BACKGROUND: Epidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. METHODS: All trainees who were scheduled to commence their obstetric anaesthesia training were invited to participate. Novices undertook intensive PbP training with one-to-one supervision by an anaesthetist trained in PbP. Trainees proceeded to the clinical phase only after attaining the pre-defined proficiency benchmark. All subsequent attempts at labour epidural catheter placement were evaluated. RESULTS: All 12 novice trainees who were scheduled for their initial exposure to obstetric anaesthesia completed PbP training in epidural catheter insertion successfully. The average duration of the training courses was 70 (SD 11) min. Trainee characteristics were broadly similar. They performed a total of 180 labour epidural catheter placements with an overall epidural failure rate of 12.2% (22/180). The proportion of supervisor takeover was 6% (11/179). The incidence of complications was 4% (8/180) and difficulty in epidural catheter insertion due to patient factors was 16% (29/180). Patient satisfaction rates were 80% (satisfied or very satisfied), with 20% unsatisfied with their experience of epidural insertion. CONCLUSION: In our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.
Subject(s)
Analgesia, Epidural , Analgesia, Obstetrical , Anesthesia, Epidural , Internship and Residency , Labor, Obstetric , Female , Humans , PregnancyABSTRACT
OBJECTIVE: To determine if photographs may be used instead of dental study models to assess the outcome of primary surgery in 5- to 6-year-olds who were born with complete unilateral cleft lip and palate. DESIGN: Retrospective method comparison study. SETTING: Five U.K. cleft units. SUBJECTS: Records of 96 children born with complete unilateral cleft lip and palate. METHOD: Dental study models and photographs including an overjet measurement taken from both the most prominent and retrusive tooth in each case were scored using the 5-year-olds' index. RESULTS: There was moderate to very good agreement between the methods of using study models or photographs. Intraexaminer agreement was moderate to very good for study models. For the photographs it was good to very good. Overall interexaminer agreement was moderate for both study models and photographs. CONCLUSIONS: When impressions are difficult to obtain, intraoral photographs with clinically recorded overjet measurements may be used for the 5-year-olds' index.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Models, Dental , Photography, Dental , Child, Preschool , Female , Humans , Male , Retrospective Studies , Treatment Outcome , United KingdomABSTRACT
The chance discovery of a foreign object embedded in a tooth is uncommon, and requires radiographic examination to determine the composition and location of the object. The authors describe the case of an 11-year-old boy who presented with a staple lodged in the root canal of the maxillary left permanent central incisor. This staple was localized using parallax techniques and successfully removed from the canal. The radiographic techniques of localization and possible methods of removal of foreign bodies are discussed.
Subject(s)
Dental Pulp Cavity , Foreign Bodies , Child , Humans , Incisor , Male , MaxillaABSTRACT
We describe the successful use of ultrasound-guided retrieval of a submandibular stone with a basket in two patients.
Subject(s)
Salivary Duct Calculi/therapy , Submandibular Gland Diseases/therapy , Ultrasonography, Interventional , Adult , Catheterization/instrumentation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Salivary Duct Calculi/diagnostic imaging , Sialography , Submandibular Gland Diseases/diagnostic imagingABSTRACT
Hyperimmunoglobulinemia E recurrent infection syndrome (also known as Job's syndrome) is a rare multi-system primary immunological disorder in which non-immunological abnormalities of the dentition, bones and connective tissue are also seen. A previous study has reported the occurrence of dental abnormalities in three-quarters of individuals diagnosed as suffering from this condition. The present authors report the case of a boy whose prolonged retention of the primary dentition was associated with delayed eruption of permanent teeth. They emphasize the need for early intervention in order to help minimize later orthodontic problems.
Subject(s)
Dental Care for Children , Dental Care for Chronically Ill , Job Syndrome/physiopathology , Tooth Eruption/physiology , Child , Dentition, Mixed , Follow-Up Studies , Humans , Male , Malocclusion, Angle Class I/etiology , Orthodontics, Interceptive , Tooth, Deciduous/physiologyABSTRACT
Localized colitis cystica profunda developed in a fibrotic radiation-induced colonic stricture 17 years after pelvic radiation for squamous carcinoma of cervix. This uncommon pathologic entity must be distinguished from invasive adenocarcinoma of colon, and colonic radiation injury should be included with other conditions associated with colitis cystica profunda.
